Child Nutrition » Civil Rights Complaint Procedure & Form

Civil Rights Complaint Procedure & Form

If customer, parent, staff member report incident where they believe someone has been denied services due to national origin, race, color, sex, age, disability, steps below are to be follow in documenting and filing complaint.


If employee is approached they are to listen to the complaint, they are to report to their manager and the complaint form is to be completed.  The manager is to report incident and information to the CN Director.  Upon receiving complaint CN Director is to notify State Agency about the complaint.

This applies to anyone in CN Department receiving complaint, whether manager, specialist, secretary, coordinator, etc.  This also applies to any complaint where the customer (person reporting complaint) decides they do not want to be involved.  The complaint may be about what they witness happening to someone else and not to themselves.  This still needs to be documented, investigated and reported to the proper entities.  (See Complaint Form)


If complainant doesn’t want to write the complaint down, have the staff member write it down, sign & date.



In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA.  

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits.  Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339.  Additionally, program information may be made available in languages other than English.

To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: How to File a Complaint, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: 

1.mail: U.S. Department of Agriculture 
Office of the Assistant Secretary for Civil Rights 
1400 Independence Avenue, SW 
Washington, D.C. 20250-9410; 
2. fax: (202) 690-7442; or