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DD Form 2655 — a Department of Defense document. Title of record: DD Form 2655, Complaint of Discrimination in the Federal Government, June 2012. Stated purpose: Complaint of Discrimination in the Federal Government. Edition date not stated; status not stated.
Issued under not stated, with not stated as proponent. A DD number marks a Department-wide instrument: the same blank form serves every military department and the defense agencies, rather than one service alone.
Common users: service members regardless of branch, Defense civilian staff, and the offices that file, verify or retain the finished document.
Submission follows the schedule set by not stated and by local implementing procedures. This page provides the blank form for download and general orientation only.
Formats offered: PDF. Length: 3 pages. Fillable field count: roughly 54.
The xfdl release corresponds to IBM Lotus Forms. This format carried Department-wide form distribution for years and opens only in IBM Lotus Forms Viewer or a compatible client, not in a pdf reader.
Free download applies to every format listed. Any current pdf reader opens the pdf files, though field behaviour is most reliable in a full desktop reader rather than a browser preview.
What the form asks for
- For agency use.
- 1. Full name of complainant (last, first, middle initial).
- 2.a. Home telephone number (area code only).
- 2.a. Remainder of home telephone number.
- 2.b. Office telephone number (area code only).
- 2.b. Remainder of office telephone number.
- 3. Address (Street, city, state and ZIP Code).
- 4.a. Name of office that you believe discriminated against you.
- 4.b. Address of office (Street, city, state and ZIP Code).
- 4.c. Name and title of person(s) you believe discriminated against you, if you know.
- 5. Are you now working for the Federal government? Press space bar to mark X in first box if yes, second box if no.
- 5.a. Name of agency where you work.
- 5.b. Address of your agency (Street, city, state and ZIP code).
- 5.c. Title and grade of your job.
- 6. Election of representation. X first box if attorney, second if non-attorney, or third if no representation.
- a. Name of representative.
- b. Address (include Zip Code).
- c. Telephone (include area code).
- d. Fax (include area code).
- e. E-mail address.
- 7. Date on which most recent alleged discrimination took place: four digit year, two digit month, two digit day.
- 8. X why you believe you were discriminated against. a. Race.
- If checked, state your race.
- b. X if color.
Order of completion: identification block first, substantive entries second, certification and signature last. The blank is laid out in that sequence and the sequence is not arbitrary — later entries often depend on data established in the header.
The current edition is not stated. Superseded editions of DD forms are frequently rejected at the receiving office, since Department-wide forms change centrally and older layouts lose their field correspondence. Edition date appears in the lower corner of the printed blank.
Signature is manual ink on printed copies and digital where the receiving system accepts it. A typed name in a signature field is a name, not a signature. Common Access Card credentials support digital signature in pdf where the form and the reader permit.
Privacy Act Statements accompany DoD forms that gather personal identifiers. Content of the statement: legal authority, principal purpose, routine uses, and the effect of declining to provide the information. It is printed on the form for that reason.
Frequent defects: obsolete edition, unfilled required boxes, handwriting that fails on reproduction, non-conforming date format, and certification without a corresponding date.
Field-level instructions appear on the form itself and in not stated. The directive is the controlling text.
After completion, the copy goes to the office designated by not stated or by local procedure. Retention of a personal copy is ordinary practice and costs nothing.
Related documents are located by series and number. DD forms sit in a single Department-wide sequence, so a form referenced inside DD Form 2655 is normally found by its number alone, without regard to service.
A DD number and a DA number may appear in the same instruction without being related. DA forms belong to the Army alone; DD forms belong to the Department and are administered at Department level. The sequences are independent.
Editions change because the underlying directive changes, because collection requirements are revised, or because Privacy Act language is updated. Checking the edition date at the point of download is the practical response.
The material here is descriptive. Nothing on the page constitutes legal or procedural advice, and no statement here determines whether a submitted form will be accepted. Such questions go to not stated, a servicing administrative office, or the authority identified in not stated.
Questions and answers
- What is DD Form 2655?
- DD Form 2655, Complaint of Discrimination in the Federal Government, June 2012
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?