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Ombudsman Complaint Form

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Contact Information

First Name *

Last Name *

Phone Number *

Email Address *

Date of Birth *

Month

Day

Year

Address Line 1

Address Line 2

City

State

Zip

Child's Information

First and Last Name of Child *

Date of Birth *

Month

Day

Year

Relationship to Child *

Need to add another child?

Yes

No

First and Last Name of Child (2) *

Date of Birth Child (2) *

Month

Day

Year

Relationship to Child (2) *

Need to add another child?

Yes

No

First and Last Name of Child (3) *

Date of Birth Child (3) *

Month

Day

Year

Relationship to Child (3) *

Need to add another child?

Yes

No

First and Last Name of Child (4) *

Date of Birth Child (4) *

Month

Day

Year

Relationship to Child (4) *

Additional Information

Type of Concern *

Case Manager's Name

Complaint

What resolution are you looking for?

What steps have you taken to resolve the problem? Please include names of people you have worked with and other offices you reported the complaint to.

Other

This complaint form does not replace the formal grievance process or reporting abuse/neglect to the hotline.

By submitting this form, I certify that the information provided is complete and accurate to the best of my knowledge.

I understand that in order to resolve my complaint, the Office of the Ombudsman may address my complaint with the person about whom I am complaining as well as DCS management staff and review my DCS case records and/or court records as needed, and that a final resolution may take some time.

The issue about which I am complaining is not a report of abuse and/or neglect. Complaints of this nature should be directed to the Child Abuse Hotline, 1-888-767-2445, and/or the appropriate law enforcement agency.

Privacy Notice: The Arizona Department of Child Safety will only use the last four (4) numbers of your social security for verification.

Read our Privacy Policy Statement here.

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Complaint or Disagreement

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Issues or concerns with a DCS Case

Please contact the DCS Office of the Ombudsman at:
1-877-527-0765 or (602) 364-0777

Resource Family Issues:

Please Contact the Foster Care and Adoptive Family Liaison at (877) KIDS-NEED-U

Download a copy of the Client Grievance Form - CSO-1016A
Obtenga una copia del Formulario de Queja de Cliente - CSO-1016A-S
DCS Office of the Ombudsman/Grievance Policy

For Additional help:

The Parent Assistance Program, operating through the Administrative Office of the Courts, provides a hotline designed to help parents, guardians or custodians. The Parent Assistance Program can:

Assist callers in understanding the Arizona dependency process;
Without giving legal advice, offer options and resources related to dependency issues;
Help to identify resources for family issues.

TO CONTACT THE PARENT ASSISTANCE PROGRAM CALL:
Phoenix: (602) 452-3580
Statewide toll-free: 1-800-732-8193
TDD Line (602) 452-3545

The Arizona Ombudsman Citizen’s Aide's Office is available to handle inquires, concerns and complaints about agency actions, including DCS. This office may be able to help you to resolve your complaint.

TO CONTACT THE OMBUDSMAN-CITIZEN’S AIDE OFFICE CALL:
Phoenix: (602) 277-7292

Arizona Department of Child Safety

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Ombudsman Complaint Form

Complaint or Disagreement

Issues or concerns with a DCS Case

Resource Family Issues:

For Additional help:

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