Document
Discrimination Complaint Form
ICR 201001-0960-008 · OMB 0960-0585 · Object 16742901.
This document may belong to an older filing. More recent activity for OMB 0960-0585:
Document Viewer [pdf]
Status: No verified local artifact is currently available. The document remains flagged for repair and upstream re-check.
Queue: Repair is queued and waiting for the next worker pass. (priority 20 · next 2026-06-12 17:47:56)
Missing: pdf
No local or Spaces-backed artifact is available yet for this document.
Loading document viewer…
Document Metadata
| File Type | application/octet-stream |
|---|---|
| File Title | Discrimination Complaint Form |
| Subject | The purpose of this form is to assist you in filing a complaint with the Social Security Administration (SSA). |
| Author | SSA |
| File Modified | 2009-11-25 |
| File Created | 2009-09-09 |
| Conversion State | failed_conversion |