TX HHS Form H4870. Client Complaint of Discrimination

The TX HHS Form H4870, Client Complaint of Discrimination, is a tool used to report incidents of discrimination against individuals in Texas. This form helps resolve issues related to unfair treatment based on various factors such as race, religion, age, sex, national origin, disability, or political beliefs.

This form requires the client's name, area code and phone number, and a detailed description of the incident, including the date it occurred. The client must also specify the type of discrimination they believe they have experienced, such as rude treatment, benefit denial, or sexual harassment. Additionally, the form asks for a signature and date from the client.

The Texas Health and Human Services Commission (HHSC) regional staff will use this form to investigate complaints and take appropriate action. The HHSC also provides information on an individual's right to request and review their personal data, as well as correct any incorrect information. This form should be used by individuals who believe they have been discriminated against and need assistance from the HHSC.