Irs Complaint Form printable pdf download

Irs Complaint Form

Internal Revenue Service

Civil Rights Division

Equity, Diversity and Inclusion Operations

1111 Constitution Avenue, NW

Washington, DC 20224

COMPLAINT FORM

The purpose of this form is to assist you when filing a civil rights complaint with the

Department of the Treasury - Internal Revenue Service. You are not required to use this

form. A letter with the necessary complaint information will be sufficient to file a

complaint.

Under no circumstances will the Internal Revenue Service tolerate discrimination by its

employees, grantees, contractors and/or subcontractors.

Any person who believes that he/she has been discriminated against in programs or

activities conducted by the Internal Revenue Service may file a complaint in writing

or use this form. If you need assistance completing the form, you may contact us at

(202) 317-6925.

1. State your name and address (print clearly):

Name:

Address:

Telephone:

Home: (

)

Work or Cell: (

)

Email:

2. Who do you believe discriminated against you? Provide as much information as possible.

Name Agency or Entity:

Address:

Telephone:

Home: (

)

Work or Cell: (

)

3. Please indicate below the basis(es) on which you believe the discriminatory act(s) occurred:

Race:

Color:

National Origin:

Sex:

Age:

Disability:

Other:

Irs Complaint Form