Procedures Manual For Processing External Complaints of Discrimination
APPENDIX A
HCR's
Memorandum
Processing
Complaints Filed Under Title VI of
the
Civil Rights Act of 1964 (Title VI) and the Americans
with Disabilities Act of 1990 (ADA)
Dated
January 18, 2008 to
Division Administrators/Assistant Division
Administrator
with Attached Letter Dated March 22, 2006
Processing
Complaints Filed Under Title VI and ADA
APPENDIX B
COMPLAINT FORM
Discrimination Complaint
| Name |
Phone |
Name of Person(s) That Discriminated Against You |
| Address |
Location and Position of Person (If Known) |
| City, State, Zip |
City, State, Zip |
Discrimination
Because of: |
 |
Race |
|
color |
|
National Origin Sex |
|
Age |
|
Disability |
|
Retaliation |
|
Date of Alleged Incident |
Explain As Briefly And Clearly As Possible What
Happened And How You Were Discriminated Against. Indicate Who Was Involved.
Be Sure To Include How Other Persons Were Treated Differently Than
You. Also Attach Any Written Material Pertaining To Your Case.
|
APPENDIX C
INVESTIGATIVE CASE FILE
Format for the Investigative Case File
The investigative case file will include the following:
A Table of Contents should be the first page of the investigative
case file. This entry describes each section in the investigative case file
and identifies each entry under each Tab.
Tab 1
- FHWA's Letter of
Finding
- Settlement Agreement
Tab 2
- Investigative
Report/Report of Investigation
Tab 3
Tab 4
- Evidence – All documentary
evidence relating to the case — records, interview statements, etc. Each body
of evidence should be sub-tabbed, along with a cover sheet, identifying the
documents.
Tab 5
- Correspondence Sent
to/from the Respondent – All external correspondence is included under this section.
Enter external correspondence chronologically (i.e., most recent first),
assigning sequential letters of the alphabet, e.g., A, B, C, D, etc.) to
identify each exhibit, if necessary.
Tab 6
- Correspondence Sent
to/from the Complainant
Tab 7
Tab 8
- Investigator's
Documents – The IP and notes from the investigator's analysis of the
evidence.
Tab 9
- Internal Agency
Correspondence – This section contains interoffice/interagency documents (e.g., memorandums,
e-mails).
APPENDIX C-1
INVESTIGATOR'S
LOG
(Title VI and
Section 504/ADA Complaints)
INVESTIGATIVE LOG
APPENDIX C-2
INFORMAL SETTLEMENT AGREEMENT
(Title VI/Section 504/ADA
Complaints)
FEDERAL HIGHWAY ADMINISTRATION
U.S. DEPARTMENT OF TRANSPORTATION
_________________________________
Complainant |
Case Number: |
_________________________________
Respondent
_________________________________ |
|
INFORMAL SETTLEMENT
AGREEMENT
IT IS HEREBY AGREED by and between (NAME) hereinafter
referred to as the complainant, and the (NAME), herein after
referred to as the respondent as follows:
Section One: Purpose
This agreement is made between the parties for the complete
and final settlement of their claims, differences, and actions with respect to
the matters described below.
Section Two: Description of Allegation
The complainant initiated the complaint of discrimination by
a complaint filed on (Date). The complainant alleged that (STATEMENT
OF ALLEGATION)
Section Three: Terms of Settlement
The complainant and the respondent enter into this agreement
without any finding of discrimination having been determined. The parties agree
to the following, which will resolve and settle all claims and issues arising
from the above‑mentioned allegation:
1.____________________________________________________________________
2.____________________________________________________________________
3.____________________________________________________________________
- The
parties agree that this settlement shall not constitute an admission of
discrimination or violation of any provision of law on the part of the
respondent.
- It is
understood that if the respondent fails to fulfill or rescinds any provision of
this agreement, the complainant, upon written request, shall be entitled to
reinstate the matter for further processing from the point processing ceased.
- It is
understood that if the complainant fails to comply with the responsibilities
under the terms of the agreement, the agreement may be terminated and any
subsequent complaint based on the same issues will be rejected or cancelled.
- The
parties agree that this agreement constitutes the sole and complete
understanding between them. No other promises or agreements shall be binding
unless signed by the parties and made a part of this agreement.
- The
parties agree that this settlement shall become effective on the date that
the last signatory signs this agreement.
_____________________________________
Complainant |
_______________________
Date |
_____________________________________
Respondent |
_______________________
Date |
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