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a, Name, address, and telephone number or other means of contacting the <br />complainant, <br />b. The specific location and name of the State agency, local agency, or <br />other sub recipient delivering the service or benefit, <br />c. The nature of the incident or action that led the complainant to feel <br />discrimination was a factor, and an example of the method of <br />administration that is having a disparate effect on the public, potential <br />eligible persons, applicants, or participants, <br />d. The basis on which the complainant believes discrimination exists. The <br />bases for nondiscrimination are race, color, national origin, age, disability <br />or sex. USDA -FNS also prohibits discrimination on the basis of religion <br />and political beliefs, <br />e. The names, telephone numbers, titles, and business or personal <br />addresses of persons who may have knowledge of the alleged <br />discriminatory action, and <br />f. The date(s) during which the alleged discriminatory actions occurred or, <br />if continuing, the duration of such actions. <br />b. Complaints are immediately logged into a separate access database or <br />computerized tracking system for easy identification. <br />13. Investigation <br />1. A designee of the Division/Institution Director, agency Director or an <br />appropriate individual shall conduct an investigation of the allegations of the <br />complaint. The investigation shall afford Fill interested persons and their <br />representatives, if any, an opportunity to submit evidence relevant to the <br />complaint. <br />2, Designee of the Divisionlinstitation Director, agency Director or an appropriate <br />individual shall provide information at the program delivery site advising program <br />applieaatslparticipants of the option to file a complaint with USDA -FNS or US <br />DHHS, or the State agency. <br />3. Designee of the Division(Institution Director, agency Director or an appropriate <br />individual shall accept and acknowledge complaints filed with the agency <br />informing the complainant of the action planned or requesting additional <br />information needed for clarification within five (S) calendar days. <br />12 <br />Attachment number 1 \n <br />F -9 Page 171 <br />