Complainant Information

This form is for you to submit complaints related to the Child and Adult Care Food Program (CACFP). The California Department of Social Services (CDSS) will forward any complaints alleging discrimination to the USDA Office of the Assistant Secretary for Civil Rights for investigation as required by Federal law. If you have questions about using this form, or if you would prefer to submit a complaint by phone or email, please contact CDSS’ CACFP Branch at 916-651-5400 or by email at CACFPCivilRights@dss.ca.gov.

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* 1. What is your full name?

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* 2. What is your address?

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* 3. What is your primary phone number?

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* 4. What is your email address?

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* 5. Would you like to keep your personal information anonymous?

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