What is the basis of the alleged discrimination? (Circle only those that apply to your complaint). □. Age. □.A Charge of Discrimination can be completed through our EEOC Public Portal after you submit an online inquiry and we interview you. Employees are encouraged to use the electronic or PDF versions of this form when making a complaint of discrimination, harassment, or workplace bullying. Who do you believe discriminated against you? Include the name(s) of person(s) involved in the alleged discrimination (if known). 6. 1) Please fill out the complaint form, answering all of the questions. USDA prohibits discrimination against its customers. PURPOSE: The purpose of this form is to assist you in filing a discrimination complaint. To file a discrimination complaint, complete a Discrimination Complaint Form.