DSHS Form 22-171 Discrimination Complaint - Washington

DSHS Form 22-171 Discrimination Complaint - Washington

What Is DSHS Form 22-171?

This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DSHS Form 22-171?
A: DSHS Form 22-171 is a Discrimination Complaint form used in Washington.

Q: What is the purpose of DSHS Form 22-171?
A: The purpose of DSHS Form 22-171 is to file a complaint regarding discrimination in a Washington State Department of Social and Health Services (DSHS) program.

Q: Who can file a discrimination complaint using DSHS Form 22-171?
A: Any individual who believes they have experienced or witnessed discrimination in a DSHS program can file a discrimination complaint using DSHS Form 22-171.

Q: What information do I need to provide on DSHS Form 22-171?
A: You will need to provide your personal information, details about the alleged discrimination, and any supporting documentation.

Q: How do I submit DSHS Form 22-171?
A: You can submit DSHS Form 22-171 by mail or by fax to the address or fax number provided on the form.

Q: What happens after I submit DSHS Form 22-171?
A: After you submit DSHS Form 22-171, the complaint will be reviewed by the DSHS Civil Rights Compliance Office and appropriate action will be taken if necessary.

Q: Is there a deadline for filing a discrimination complaint using DSHS Form 22-171?
A: Yes, the complaint should be filed within 180 days of the alleged discrimination.

Q: Can I file a discrimination complaint anonymously using DSHS Form 22-171?
A: No, you are required to provide your name and contact information when filing a discrimination complaint using DSHS Form 22-171.

Q: Can I get assistance in filling out DSHS Form 22-171?
A: Yes, you can contact the DSHS Civil Rights Compliance Office for assistance in filling out DSHS Form 22-171.

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Form Details:

  • Released on March 1, 2019;
  • The latest edition provided by the Washington State Department of Social and Health Services;
  • Easy to use and ready to print;
  • Available in Lao;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DSHS Form 22-171 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.

Download DSHS Form 22-171 Discrimination Complaint - Washington

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