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Privacy Act Statement

The Americans with Disabilities Act of 1990, 42 U.S.C. 12131-12134, and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794, authorize the solicitation of the information for this form. Providing the information is voluntary, except that failure to provide such information may result in the Department of Justice's Disability Rights Section (DRS) being unable to process your complaint. The principal purpose of collecting information from you is for DRS's authorized civil rights compliance and enforcement activities. DRS will not disclose your name or other identifying information about you unless it is necessary for enforcement activities against an entity alleged to have violated federal law, required to be disclosed under the Freedom of Information Act, 5 U.S.C. 552, disclosure is permitted pursuant to the Privacy Act, or is otherwise required by law. The records that you provide to DRS may be disclosed in accordance with the provisions of the Privacy Act, including: to appropriate Federal, State, or local agencies; Members of Congress or staff; volunteer student workers within the Department of Justice so that they may perform their duties; the news media and the public pursuant to 28 C.F.R. 50.2, unless it is determined that release of the specific information in the context of a particular case would constitute an unwarranted invasion of personal privacy; the National Archives and Records Administration and General Services Administration to perform records management inspection functions in accordance with their legal responsibilities, or; for other routine uses indicated in the JUSTICE/CRT-001 "Central Civil Rights Division Index File and Associated Records" system of records notice. To view the routine uses applicable to this system of records, please consult the system of records notice, as amended, at the following links:

68 Fed. Reg. 47610, 611 at https://www.gpo.gov/fdsys/pkg/FR-2003-08-11/pdf/03-20342.pdf
70 Fed. Reg. 43904 at https://www.gpo.gov/fdsys/pkg/FR-2005-07-29/pdf/05-14944.pdf
82 Fed. Reg. 24147 at https://www.gpo.gov/fdsys/pkg/FR-2017-05-25/pdf/2017-10780.pdf