DD Form 2655 Complaint of Discrimination in the Federal Government

How to Fill Out DD Form 2655?

DD Form 2655 instructions are as follows:

1. The complainant has to provide their name and address (complete with ZIP code) along with their home and office phone numbers in Boxes 1 through 3.
2. Box 4 requires the information on the Federal office the complainant believes has discriminated against them. This includes the name and address of the office where the discrimination occurred. The name and title of the perpetrator must be reported on DD Form 2655 (if that information is known to the applicant).
3. Box 6 is for electing a representative. The complainant can choose an attorney, a non-attorney, or to continue without any representation. The chosen representative must be identified and their name, address, phone number, and e-mail should be specified in the corresponding boxes.
4. Box 7 requires the date when the most recent case of discrimination took place. The reason for discrimination should be indicated in box 8. Box 9 provides space for a detailed explanation of the case. If the provided space is not enough, the complainant can continue on another sheet of paper.
5. Box 10 requires specifying whether the complainant has discussed the issue with an EEO counselor. A positive answer requires the name of the counselor in Box 11. Box 12 should indicate whether the issue had been appealed to the Merit Systems Protection Board (MSPB) or filed under a Union Negotiated Grievance Procedure. Positive answers require completing Boxes 12a through 12c.
6. The corrective action the complainant believes will resolve the case should be provided in Box 13. If there are any witnesses that can assist in the investigation of the case, their names should be listed in Box 14. The complainant must sign and date the form in Boxes 15 and 16.
7. If the discrimination complaint is filed against the Immediate Office of the Secretary of Defense, the Joint Staff, or other activities that receive administrative support from Washington Headquarters Services, then the completed DD Form 2655 should be submitted to the EEO officer or the Director. Otherwise, the form should be submitted to the personnel authorized to receive this type of complaint in the specific agency.