In the quest for an inclusive society where individuals with disabilities receive fair treatment and equal opportunities, the DHS-866 form emerges as a pivotal instrument for advancing these ideals. This form serves as a formal complaint under the Americans with Disabilities Act (Title II) and Section 504 against the Michigan Department of Human Services, outlining a structured process for individuals to voice allegations of discrimination based on disability. As it mandates complete and accurate information, the form requires the complainant's details, including name, address, telephone numbers, and the specifics of the person completing the form if it's not the complainant. The essence of the complaint, such as the description of the discriminatory event, the involved parties, and the time and place, is crucial for a thorough investigation. Moreover, the form inquires whether the complaint has been filed with other agencies or courts, hinting at the interconnectedness of various civil rights enforcement mechanisms. The form, while appearing as a mere bureaucratic requirement, embodies the legal avenues available to uphold the dignity and rights of individuals with disabilities, ensuring that their grievances are heard and addressed appropriately. Emphasizing voluntariness in response with no penalties for filing, the DHS-866 form underscores the commitment of the Department of Human Services to non-discrimination and encourages individuals facing barriers to seek restitution and justice.
| Question | Answer |
|---|---|
| Form Name | Form Dhs 866 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | dhs 866 michigan, Lansing, VII, discriminate |
COMPLAINT UNDER AMERICANS WITH DISABILITIES ACT
(Title II) and Section 504
Michigan Department of Human Services
Instructions: Please fill out this form completely, in black ink or type. Sign and return to the address on page 2.
Complainant Name:
Address:
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Person Completing This Form: |
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(if other than the complainant) |
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Telephone: Home: |
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Business: |
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County/Program that you believe has discriminated against you:
Name:
Address:
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State
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Telephone Number:
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When did the event occur? Date:
Describe the event providing the name(s) where possible for the individuals who were involved (use space on page
2 if necessary):
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Has the complaint been filed with the Michigan Department of Civil Rights or the Federal Department of Justice or any other federal agency or court?
Yes
No
If yes give name of agency or court:
Contact Person:
Address:
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Telephone Number:
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Date Filed:
Do you intend to file with another agency or court?
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Agency or Court:
Address:
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State
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Telephone Number:
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Additional space for answers:
Signature: |
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Return to:
Office of Human Resources
PO Box 30037
Lansing, MI 48909
Phone: (517)
Fax: (517)
Authority: |
Sec.709(c), Title VII, Civil Rights Act of |
Department of Human Services (DHS) will not discriminate against any individual or |
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group because of race, religion, age, national origin, color, height, weight, marital status, |
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1969, as amended. |
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sex, sexual orientation, gender identity or expression, political beliefs or disability. If you |
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Response: Voluntary |
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need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, |
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Penalty: |
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you are invited to make your needs known to a DHS office in your area. |
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