IER Charge Form

About This Form

U.S. immigration law prohibits certain types of employment discrimination and retaliation, including: (1) citizenship status discrimination with respect to hiring, firing, or the recruitment or referral for a fee of protected individuals; and (2) national origin discrimination (involving employers with four to fourteen employees) with respect to the hiring, firing, or recruitment or referral for a fee of all individuals who are lawfully authorized to work in the United States. The law also prohibits (3) unfair documentary practices which occur when an individual, business, organization or other entity refuses to accept a valid document, requests specific documentation or demands more or different documents than are required for completing the Form I-9 because of an individual’s citizenship status or national origin. The law also prohibits (4) retaliation against individuals for asserting rights protected under the anti-discrimination provision of the immigration law, or for having participated or assisted in an investigation conducted by this office.

Who can file a charge: Anyone who alleges they are a victim of discrimination or retaliation or an authorized person on behalf of the victim. This charge form must be submitted within 180 days of the alleged date of discrimination. Please complete this form by typing or by legibly printing the information requested, in any language. If a question does not apply to you, leave it blank.

You should complete this charge form by entering the information requested. If a question is not applicable, you should leave it blank. However, fields marked with an asterisk (*) are required. At the bottom of this form, you will need to click the "Next Step" button. To submit the form, you will have to click "Submit."

If you would like to submit an electronic charge form in a language other than English, you may click on one of the languages listed above. If IER does not have a charge form in your language, you can send us information about yourself and what happened to you in whatever language you prefer. IER will translate the information that you send us into English. IER can also contact you in your preferred language if IER has any questions for you. Below you will find instructions on how to send IER information by mail, fax, or email.

Filing Supporting Documents

You cannot attach supporting documents directly to this form. If you want to submit other documents, you can do so by Email, mail or fax (see instructions below). Please only send copies of documents, not originals. When transmitting attachments or documents relating to this form, please include the reference number that will generate once you have submitted the electronic form.

By Email:

If you provide an email address, you will receive a confirmation email once we receive your form. If you would like to attach files or documents to support your form, you may submit by emailing us at IERCharge@usdoj.gov.

By Mail:

You may mail any attachments or documents to support your form to:

Immigrant and Employee Rights Section (IER)

Civil Rights Division

US Department of Justice

950 Pennsylvania Avenue, NW (4CON)

Washington, DC 20530

By Fax:

You may also fax attachments or documents to support your form to 202-616-5509.

Get Help:

Questions concerning this charge form can be directed to IER by telephone at 1-800-255-7688 (toll free), or TTY 1-800-237-2515 (toll free)

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Employer Information

Who committed the alleged discriminatory act?

* Required field

Employer name

Please enter a valid employer name.

Mailing address 1

Please enter a valid mailing address.

Mailing address 2

Please enter a valid mailing address.

City

Please enter a valid city.

State

Please select a valid state.

Zip code

Ex: 12345-6789

Please enter a valid zip code.

Phone number

Please enter a valid phone number.

Number of employees the employer employs

Please select a valid option.

Fewer than 4

4-14

15 or more

Do not know / Unable to estimate

If you know, does the Employer operate under any other names?

Please select a valid option.

Yes

If yes, under what other name(s)?

Please enter a valid employer name.

Type of Discrimination Alleged

* Required field

What type of discrimination is alleged? Check all that apply

Please select a valid option.

National Origin Discrimination The Injured Party was discriminated against with respect to hiring, firing, or recruitment or referral for a fee because the Injured Party is from a particular country or part of the world, because of the Injured Party’s ethnicity or accent, or because of limited English ability.

Citizenship Status Discrimination The Injured Party was discriminated against with respect to hiring, firing, or recruitment or referral for a fee because the Injured Party is, or is not, a U.S. citizen, or based on the Injured Party’s immigration status.

Retaliation for Protected Activity Under 8 U.S.C § 1324b The Injured Party filed a charge of discrimination, complained about discrimination, participated in the investigation or case of another individual’s discrimination claim, or otherwise asserted a right under the anti-discrimination provision, and, as a result, the Injured Party was retaliated against, intimidated, threatened, or coerced.

Unfair Documentary Practices The individual, business, organization, or other entity refused to accept a valid document, requested specific documentation from the Injured Party, or demanded more or different documents than are required for completing the Employment Eligibility Verification (Form I-9 or E-Verify) process because of the Injured Party’s citizenship or national origin.

Date and Place the Discrimination Occurred and the Specifics of the Discrimination Alleged

When did the discrimination occur?

Month

Please enter a valid month.

Day

Please enter a valid day.

Year

YYYY

Please enter a valid year.

Where did the discrimination occur?

Place

Please enter a valid place.

City

Please enter a valid city.

State

Please select a valid state.

Explain in detail what happened when the Injured Party was discriminated against. Include whether the Injured Party was fired, laid-off, not hired, delayed in starting work, asked for additional documents, retaliated against, or other, and describe what happened in detail.

Please enter a valid description.

You can enter up to 4000 characters

Filing Supporting Documents

You cannot attach supporting documents directly to this form. If you want to submit other documents, you can do so by using the following instructions. Please only send copies of documents, not originals. When transmitting attachments or documents relating to this form, please include the reference number that will generate once you have submitted the form.

By Email:

By Mail:

You may mail any attachments or documents to support your form to:

Immigrant and Employee Rights Section (IER)

Civil Rights Division

US Department of Justice

950 Pennsylvania Avenue, NW (4CON)

Washington, DC 20530

By Fax:

You may also fax attachments or documents to support your form to 202-616-5509.

Charging Party Contact Information

The Charging Party is the person who files this form. Most times the Charging Party is the same as the Injured Party, but there are times when they are different, such as when someone files this form on behalf of an Injured Party

* Required field

Is the Charging Party the same as the Injured Party?

Please select a valid option.

Yes

Full Name

Please enter a valid name.

Title

Please enter a valid title.

Entity Name

Please enter a valid name.

Mailing address 1

Please enter a valid mailing address.

Mailing address 2

Please enter a valid mailing address.

City

Please enter a valid city.

State

Please select a valid state.

Zip code

Ex: 12345-6789

Please enter a valid zip code.

Phone number

Please enter a valid phone number.

Best time to contact

Please select a valid time.

Please enter a valid email address.

Charges Filed with Other Federal or State Agencies Based on the Same Facts

* Required field

Has a charge based on this set of facts been filed with any federal, state, or local governmental agency?

Yes

Full Agency Name

Please enter a valid name.

Mailing address 1

Please enter a valid mailing address.

Mailing address 2

Please enter a valid mailing address.

City

Please enter a valid city.

State

Please select a valid state.

Zip code

Ex: 12345-6789

Please enter a valid zip code.

Phone number

Please enter a valid phone number.

Date Filed

Month

Please enter a valid month.

Day

Please enter a valid day.

Year

YYYY

Please enter a valid year.

File # (if known)

Please enter a valid file number.

Investigator name (if known)

Please enter a valid investigator name.

If IER determines that another government agency would be the appropriate office to investigate your claim, would you like IER to forward your charge to that office?

Please select a valid option.

Yes

No, contact me before forwarding my charge

Communications with IER

* Required field

Have you previously spoken or communicated with IER prior to filing this charge?

Yes

When?

Month

Please enter a valid month.

Day

Please enter a valid day.

Year

YYYY

Please enter a valid year.

How?

Please select a communication method.

Telephone Hotline

Outreach Event

If you know, who in IER did you communicate with?

Please enter a valid name.

Affirmation

* Required field

If this charge is being filed by the INJURED PARTY:

As a person alleging that I have been injured by an unfair immigration-related employment practice, I understand that IER may find it necessary to reveal my identity and other information during the conduct of the investigation of my charge, during any hearing or other proceeding as a result of my charge, or in limited circumstances in response to inquiries under the Freedom of Information Act. I give my consent to such disclosure. I affirm that, to the best of my knowledge, the information provided on this form is true.

If this charge is being filed by an AUTHORIZED REPRESENTATIVE of the Injured Party:

I affirm that, to the best of my knowledge, the information provided on this form is true and that I am authorized to file this charge on behalf of the Injured Party. I understand that IER may find it necessary to reveal my identity and/or the Injured Party's identity during the conduct of the investigation of this charge, during a hearing or other proceeding as a result of this charge, or in limited circumstances in response to inquiries under the Freedom of Information Act. I give my consent to such disclosure.

Privacy Act Statement

The authority for requesting this information from the Injured or Charging Party is contained in 8 U.S.C. § 1324b. The information that the Injured or Charging Party provides will be used principally for investigating and processing the charge of prohibited discrimination; however, the information may also be used for other legitimate purposes, as detailed in the Department of Justice’s Federal Register Notice published in the Federal Register at 68 Fed. Reg. 47611 (August 11, 2003) describing the routine uses of the information obtained by the Civil Rights Division. While completing the form is voluntary, the Injured or Charging Party’s failure to provide the information requested on this form could lead to the charge being dismissed or not being accepted. Knowingly making false statements on this form is punishable under 18 U.S.C. § 1001.

Paperwork Reduction Act Notice

This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is necessary to enable the Department to process and investigate individual charges of discrimination in violation of 8 U.S.C. § 1324b as required by statutory mandate. The use of this collection instrument will facilitate this process by assisting charging parties to identify and provide the information necessary to initiate an investigation.

The estimated average burden associated with this collection is 30 minutes per charging party or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to IER’s Special Policy Counsel, USDOJ-CRT-IER, 950 Pennsylvania Avenue, NW-4CON, Washington, DC 20530.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

OMB Number: 1190-0018

Revised date: January 2025

IER Charge Form

About This Form

Filing Supporting Documents

By Email:

By Mail:

By Fax:

Get Help:

Error

Employer Information

Type of Discrimination Alleged

Filing Supporting Documents

By Email:

By Mail:

By Fax:

Injured Party Contact Information

Charging Party Contact Information

Charges Filed with Other Federal or State Agencies Based on the Same Facts

Communications with IER

Optional Information

Affirmation

If this charge is being filed by the INJURED PARTY:

If this charge is being filed by an AUTHORIZED REPRESENTATIVE of the Injured Party:

Privacy Act Statement

Paperwork Reduction Act Notice

IER Charge Form

About This Form

About This Form

Instructions for Filling Out This Form

Filing Supporting Documents

By Email:

By Mail:

By Fax:

Get Help:

Error

Employer Information

Type of Discrimination Alleged

Filing Supporting Documents

By Email:

By Mail:

By Fax:

Injured Party Contact Information

Charging Party Contact Information

Charges Filed with Other Federal or State Agencies Based on the Same Facts

Communications with IER

Optional Information

Affirmation

If this charge is being filed by the INJURED PARTY:

If this charge is being filed by an AUTHORIZED REPRESENTATIVE of the Injured Party:

Privacy Act Statement

Paperwork Reduction Act Notice