Social Security Forms

Form SSA-437

Social Security Discrimination Complaint

You may use this discrimination complaint form to file a Civil Rights complaint with the Office of General Counsel for Social Security.

How to Obtain the Form

Below you will find Form in Portable Document Format (PDF). To print the PDF version, you will need the Adobe Acrobat reader software. If you do not already have this special software, see our page on downloading and printing PDF documents.

After you download the Adobe Acrobat Reader, come back to this page and download the PDF version of the SSA-1696:

Social Security Discrimination Complaint (SSA-437)

Send the Form

Where To Send The Form

To file a complaint, please mail a completed and signed discrimination complaint and consent release to:

Social Security Administration
Office of the General Counsel
Room 617 Altmeyer Building
6401 Security Blvd
Baltimore, MD 21235-0001


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