| Complaint Contact Information | |
| Name | |
| Street Address, City, State, Zip | |
| County | |
| Area Code / Phone | |
| Email Address | |
Complaint Information
- Specific name and location of the entity and individual delivering the service or benefit
- Describe the incident or action of the alleged discrimination or give an example of the situation that has a discriminatory effect on the public, potential program participants, or current participants
- On what basis does the complainant feel discrimination exists (race, color, national origin, sex, age, disability, creed, sexual orientation, religion, gender identity, political party affiliation, actual/potential parental/family/marital status)?
- List the names, titles, and business addresses of persons who may have knowledge of the alleged discriminatory action
- List the date(s) during which the alleged discriminatory actions occurred, or if continuing, the duration of such actions
| Date Complaint Received | |
| Person Receiving Complaint | |
| Actions Taken |
USDA is the cognizant agency for the Child Nutrition Programs listed and therefore is the first contact for the six protected classes listed in #1 above. A complainant has 180 days from the date of the alleged discriminatory act to submit a complaint. The complaint must be submitted to the Food and Nutrition Services (FNS) Civil Rights Division (CRD) within 5 calendar days of receipt by the State or local office. The email address for submission of a complaint is: program.intake@usda.gov or mail to USDA, Office of the Assistant Secretary for Civil Rights, 1400 Independence Ave, SW, Stop 9410, Washington, D.C. 20250-9410. In addition to sending the complaint to USDA, the SFA is required to send a copy of the complaint to the SA. The SA will log the complaint in the Iowa Civil Rights Complaint Log.
In Iowa, protected classes also include sexual orientation, gender identity, religion or creed and complaints can be filed up to 300 days of occurrence. The address for Iowa complaints is: Iowa Civil Rights Commission, 6200 Park Avenue, Suite 100, Des Moines, IA 50321-1270; phone number 515-281-4121, 800-457-4416; website: https://icrc.iowa.gov/.
This institution is an equal opportunity provider.
Approved: April, 2022
Revised: December, 2024