SSA-437

Complaint Form For Allegations Of Discrimination In Programs Or Activities Conducted By Social Security Administration

Download and Print the SSA-437

The purpose of this form is to assist you in filing a discrimination complaint with the Social Security Administration (SSA) regarding programs and activities that are conducted by SSA. This form is not intended to be used for complaints about employment with SSA. You are not required to use this form to file a complaint; a letter with the same information is sufficient. However, if you file a complaint by letter, you must include the same information that is requested in the form.

Complaints of discrimination usually must be filed within 180 days of the action you allege to have been based on discrimination. If the action took place more than 180 days ago, you must explain why you waited to file the complaint. SSA will waive the 180-day requirement in cases where we believe there was good cause (extenuating circumstances) for the late filing.

If you believe that SSA, an SSA employee, an SSA contractor, or an agent of SSA discriminated against you, someone you know, or a class of people in connection with an SSA program or activity, and you believe that the discrimination was based on race, color, national origin (including English language ability), religion, sex, sexual orientation, age, disability, or in retaliation for your having participated in a proceeding under this complaint process, you may file a complaint or have a representative file a complaint on your behalf. You may also file a complaint if you believe that SSA discriminated on the basis of status as a parent in education or training programs or activities conducted by SSA. To file a complaint, please mail a completed and signed discrimination complaint form and a signed consent and release form to:

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