Complaint Form
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Civil Rights Complaint Form (1153)
This form is to be used by employees, clients, consumers, program participants, and consumers of OAIV or any Sub-grantee of OAIV filing a complaint alleging discrimination against OAIV or any Sub-grantee of OAIV.
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Mississippi State Department of Health • 570 East Woodrow Wilson Dr • Jackson, MS 39216 • 866-HLTHY4U • Contact and information
