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.
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.
Form Details:
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.