OFC - Add Form

Source of complaint

Office of the Ombudsperson for Children Online Complaint Form

The Office of the Ombudsperson for Children may investigate and attempt to resolve a complaint alleging that an administrative act taken by the District of Columbia Child and Family Services Agency (CFSA) or a CFSA affiliate, without regard to the finality of the administrative act, that the Office believes to be:

(i) Inconsistent with District or federal law, regulation, or policy, or standards of good practice;
(ii) Based on mistaken facts or irrelevant considerations;
(iii) Unsupported by an adequate statement of reasons;
(iv) Performed in an unprofessional manner that is detrimental to the safety, permanency, or well-being of a CFSA child or the CFSA child s family; or
(v) Unreasonable, unfair, not aligned with the standards of practice and care, or otherwise objectionable, even though in accordance with law.

Complainant Information

Date Created *

Please Enter Your Name *

Are you 21 years of age or younger?

If yes, are you enrolled in DC Public School (DCPS)?

If yes, are you currently involved or previously involved with any of the following agencies

Other Agency

Address

Other

Email *

Telephone # *

ext.

How would you like us to contact you?

What�s the best time to contact you

Your relationship to the child(ren) *

Name of Agency (if applicable)

Where agency is located

Complaint Narrative

Briefly describe your complaint. Include a description of any laws, rules, or policies that you believe were violated, if known *

Type of Case

Select the type of case *

Name(s) of Social Worker or other staff involved

Child/Children Information

Child #1 Name

Child #1 DOB

Child #1-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

________________________________________

Child #2 Name

Child #2 DOB

Child #2-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Add a child information

Child #3 Name

Child #3 DOB

Child #3-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Add a child information

Child #4 Name

Child #4 DOB

Child 4-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Add a child information

Child #5 Name

Child #5 DOB

Child 5-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Add a child information

Child #6 Name

Child #6 DOB

Child 6-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Add a child information

Child #7 Name

Child #7 DOB

Child #7-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Add a child information

Child #8 Name

Child #8 DOB

Child #8-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Add a child information

Child #9 Name

Child #9 DOB

Child #9-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Add a child information

Child #10 Name

Child #10 DOB

Child #10-Person(s) with whom the child resides and their relationship to child (separate with commas)
Example. Jane Doe (Mother), Georgia Doe (Maternal Grandmother)

Other Adults Involved in the Case

Please provide the names of other adults involved in the case and their relationship to the child or children. Other adults can include relatives, attorneys, CASA, Guardian Ad Litem (GAL), etc. Please enter one name per field and select the relationship from the drop-down list)

Adults Involved in Complaint (separate by comma)