Fairfax County, Virginia - Northern Virginia Long-Term Care Ombudsman Program. The Long-Term Care Ombudsman has up to 45 working days to complete the investigation.If a complaint has been referred to another agency and that agency acts on the complaint and reports the final outcome to the ombudsman program, code in the. VERIFIED COMPLAINT (Form UD-2):. Field 1: Fill in the county in which the action is brought. Yes, please fill out the Owner Exemption Statement Form. Check here if specimen arrived thawed and stop completing form. Fax this form to the above fax number. Contact Student Financial Aid - contact form and information. And application for further review on CBP Form 19.