Title VI Complaint Procedure and Investigation Log

Procedure and log for recording Title VI discrimination complaints, tracking the 180-day filing window, investigation status, and resolution.

Submission Notice

• Submission type
• Submitter identity
• Consent to process personal information
  By submitting this form, you consent to the organization using the personal information provided only for complaint intake, review, investigation, resolution, recordkeeping, and required reporting. Do not include SSNs, full financial account numbers, or other unnecessary PII.
• Request anonymous submission where permitted
  Select this if you want to limit identifying information. Anonymous submissions may reduce the organization’s ability to investigate or follow up.

Complaint Intake

• Complainant name
  Optional if anonymous submission is requested or not permitted to collect. Provide only if needed for follow-up.
• Preferred contact email
  Use only if you want updates by email.
• Preferred contact phone
  Use only if you want updates by phone.
• Preferred language
  Optional. Helps support accessible communication and language assistance.
• Date of alleged discriminatory incident
  Enter the date the alleged discrimination occurred.
• Date complaint was received
  This is the date the organization received the complaint.
• Basis of complaint
  Select all that apply.
• Program, service, or activity involved
  Identify the federally funded program, service, or activity involved.
• Location of incident
  Provide the location if known.
• Complaint summary
  Describe what happened, who was involved, and what outcome is being requested. Avoid unnecessary personal details.
• Supporting documents
  Upload any relevant documents, screenshots, or correspondence.

180-Day Filing Window Review

• Days since alleged incident
  Calculated from the alleged incident date and the date received.
• Filed within 180 days
  Title VI complaints are generally expected to be filed within 180 days of the alleged discriminatory act.
• Timeliness rationale
  Document the reason for acceptance, dismissal, or exception review when the complaint is outside the 180-day window.
• Intake decision

Investigation Tracking

• Case number
  Automatically assigned complaint identifier.
• Assigned investigator
  Name or role of the assigned investigator.
• Assignment date
• Investigation status
• Status update notes
  Record progress updates, outreach attempts, and any barriers to completion.
• Interviews conducted
  Enter the number of interviews completed.
• Evidence reviewed

Findings and Resolution

• Finding
• Corrective action required
• Corrective action description
• Resolution date
• Complainant notified
• Closure notes
  Summarize final disposition, notifications, and any follow-up actions.