DHHS Customer Service Inquiry and Complaint Form

Do not include any sensitive information such as social security numbers or driver's license numbers.

* Required Field

* First Name

* Last Name

* Email

* Street Address

* Zip Code

* Phone Number

* Name of the agency for which you are making a customer service complaint:

If other, please specify:

Location (optional)

* Please explain the customer service concern or complaint you have. Please be specific and include time and date, if relevant:

Max Character Length 1,000

Attach Document(s)

Please do not include any sensitive information such as social security numbers or driver's license numbers.

Name and titles of the last contact you had with the agency: (If known)

Date of last interaction with agency:

What has been done to resolve your customer service concern or complaint?

Note: Individuals eligible for, receiving services from or benefiting from programs funded by or through the Ohio Department of Job and Family Services (ODJFS) are protected by various laws, regulations, rules, and policies against unlawful discrimination based on race, color, religion, disability, political affiliation or belief, age, sex, including sexual orientation and gender identity, and national origin. If you believe that you have been denied or delayed services for which you are eligible due to discrimination, please click here to file a civil rights complaint: https://hhs.cuyahogacounty.us/about-hhs/civil-rights.

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