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USDA Discrimination Complaint Form

AD-3027 (1/19/12) OMB Control Number 0508-0002 UNITED STATES DEPARTMENT OF AGRICULTURE ( usda ) usda Program Discrimination Complaint Form Instructions (The Complaint form is below the instructions) PURPOSE: This form may be used if you believe you have been subjected to Discrimination in any usda program or activity and you wish to file a Complaint of Discrimination .

2. What happened to you? State the date when the alleged discrimination occured and then describe what happened. If the alleged discrimination occurred more than once, please provide the other dates and describe what happened. Use additional pages, if necessary, and please include any supporting documents that would help show what happened..

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