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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 .

Federal law and policy prohibits discrimination against you based on the following: race, color, national origin, religion, sex, disability, age, marital status, sexual orientation, family/parental status, income derived from a public assistance program, and political beliefs. (Not all bases apply to all programs). 1

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