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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

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Diversity Management - Equal Employment Opportunity

HHS760 INITIAL INTAKE FORM PART 2 - E-FILE, PAGE 1 OF 4

For Aggrieved Persons (AP) wishing to begin the EEO complaint process, this form should be completed in its entirety

Privacy Act Statement - Authority: 42 U.S.C. &##167; 2000e-16 et seq., and 29 CFR &##167; 1614.106.

Principal Purpose of Form: Informal and formal taking of allegation of discrimination because of race, color, national origin, religion, sex, age, disability, or retaliation.

Routine Uses: This form and the information on this form may be used: (a) as a data source for EEO complaint information for production of summary descriptive statistics and analytical studies of complaints processing and resolution efforts and may be used to respond to general requests for information under the Freedom of Information Act: (b) to respond to requests from legitimate outside individuals or agencies (e.g., Members of Congress, The White House, the Equal Employment Opportunity Commission, or Federal Courts) regarding the status.

You must have a valid IHS web account and be logged in to file HHS760 electronically. If you do not have a web account click "Register here" and complete the form.

    
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