DC Office of Human Rights (OHR) Administrative Charge of Discrimination - Preparation Worksheet - District of Columbia

OHR INTAKE QUESTIONNAIRE PREPARATION WORKSHEET — DISTRICT OF COLUMBIA

TABLE OF CONTENTS

1. Filing Information
2. Complainant Information
3. Respondent Information
4. Type of Discrimination Claim
5. Protected Class(es)
6. Date(s) of Discrimination
7. Statement of Particulars
8. Witnesses and Comparators
9. Documentary Evidence
10. Damages and Relief Requested
11. Election of Remedies / Dual Filing Acknowledgment
12. Verification and Signature
13. Practice Notes — DC Office of Human Rights
14. Sources and References

1. FILING INFORMATION

TO: District of Columbia Office of Human Rights
441 4th Street NW, Suite 570N
Washington, DC 20001
Phone: (202) 727-4559 | Fax: (202) 727-9589 | Email: [email protected] | Web: ohr.dc.gov

OHR Docket No.: [________________________________] (assigned by OHR upon docketing)

EEOC Charge No. (if dual-filed): [________________________________]

Official OHR questionnaire selected: ☐ Employment ☐ Housing / Commercial Space ☐ Public Accommodations / Government Services ☐ Educational Institutions ☐ Other OHR program: [____________]

Questionnaire submission date: [__/__/____]

Current official form URL checked on: [__/__/____] | URL: [________________________________]

Statute(s) Invoked:

• ☐ D.C. employment discrimination — D.C. Code § 2-1402.11
• ☐ D.C. housing discrimination — D.C. Code § 2-1402.21
• ☐ D.C. public-accommodation discrimination — D.C. Code § 2-1402.31
• ☐ D.C. educational-institution discrimination — D.C. Code § 2-1402.41
• ☐ D.C. retaliation / interference — D.C. Code § 2-1402.61
• ☐ D.C. aiding or abetting — D.C. Code § 2-1402.62
• ☐ [Only after confirming the current filing arrangement and federal elements] Parallel federal basis for EEOC or another agency: [STATUTE / AGENCY / DEADLINE: ________________________________]

2. COMPLAINANT INFORMATION

Name: [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________]

Telephone: [________________________________]

Email: [________________________________]

Date of Birth (only if age claim asserted): [__/__/____]

Counsel for Complainant (if represented):

• Name: [________________________________]
• Firm: [________________________________]
• DC Bar No.: [________________________________]
• Address: [________________________________]
• Phone / Email: [________________________________]

3. RESPONDENT INFORMATION

Primary Respondent (Employer / Housing Provider / Place of Public Accommodation / Educational Institution):

• Name: [________________________________]
• Type: ☐ Private employer ☐ DC government agency ☐ Housing provider ☐ Public accommodation / government service ☐ Educational institution ☐ Labor organization ☐ Employment agency ☐ Other: [____________]
• Address: [________________________________]
• Phone: [________________________________]
• Approximate number of employees (if employer): [________________________________]

Individual Respondent(s) (name only when facts support direct liability or aiding/abetting under the applicable DCHRA provision; § 2-1402.62 is not automatic supervisor liability):

• Name: [________________________________] | Title / Role: [____________]
• Name: [________________________________] | Title / Role: [____________]

Complainant's Position / Relationship to Respondent: [________________________________]

Dates of Employment / Tenancy / Patronage / Enrollment: From [__/__/____] to [__/__/____]

4. TYPE OF DISCRIMINATION CLAIM

Check all that apply:

• ☐ Failure to hire
• ☐ Discharge / termination
• ☐ Constructive discharge
• ☐ Demotion
• ☐ Failure to promote
• ☐ Disparate pay / compensation
• ☐ Disparate discipline
• ☐ Denial of training / opportunity
• ☐ Hostile work environment / harassment
• ☐ Sexual harassment (quid pro quo)
• ☐ Failure to accommodate disability [identify the governing DCHRA provision, regulation, or parallel law for the selected sphere]
• ☐ Failure to accommodate religion
• ☐ [If separately supported] Pregnancy-related accommodation under the applicable District law: [________________________________]
• ☐ Retaliation (D.C. Code § 2-1402.61)
• ☐ Refusal to rent / sell housing
• ☐ Discriminatory housing terms / conditions
• ☐ Steering / blockbusting
• ☐ Denial of public accommodation / service
• ☐ Discriminatory educational practice
• ☐ Aiding and abetting (D.C. Code § 2-1402.62)
• ☐ Other: [________________________________]

5. PROTECTED CLASS(ES)

Protected traits differ by sphere. Check only traits listed in the governing provision selected above and confirm any exception or special rule:

• ☐ Race: [________________________________]
• ☐ Color
• ☐ Religion / Creed: [________________________________]
• ☐ National Origin: [________________________________]
• ☐ Sex (including pregnancy, childbirth, related conditions)
• ☐ Age (specify date of birth above)
• ☐ Marital Status
• ☐ Personal Appearance
• ☐ Sexual Orientation
• ☐ Gender Identity or Expression
• ☐ Family Responsibilities
• ☐ Familial Status [housing / public accommodations / education as the statute provides]
• ☐ Genetic Information
• ☐ Disability (specify): [________________________________]
• ☐ Matriculation (status as student)
• ☐ Political Affiliation
• ☐ Source of Income [housing / public accommodations / education as the governing provision provides]
• ☐ Status as Victim or Family Member of a Victim of Domestic Violence, Sexual Offense, or Stalking [employment]
• ☐ Status as Victim of an Intrafamily Offense [housing]
• ☐ Credit Information [employment]
• ☐ Sealed Eviction Record [housing]
• ☐ Homeless Status
• ☐ Place of Residence or Business [housing / public accommodations as the governing provision provides]
• ☐ Other DCHRA-protected characteristic: [________________________________]

Sphere/exemption gate: [IDENTIFY EXACT CODE SUBSECTION, RESPONDENT ROLE, AND ANY APPLICABLE EXEMPTION OR THRESHOLD: ________________________________________________]

6. DATE(S) OF DISCRIMINATION

Date of earliest alleged discriminatory act: [__/__/____]

Date of latest / most recent alleged discriminatory act: [__/__/____]

Is the discrimination ongoing or continuing? ☐ Yes ☐ No

Date Complainant first became aware of the discriminatory act ("discovery"): [__/__/____]

Was the official OHR intake questionnaire submitted within ONE (1) YEAR of the discriminatory act or its discovery, as required by D.C. Code § 2-1403.04(a)? ☐ Yes ☐ No (explain): [________________________________]

D.C. government employee gate: ☐ Not applicable ☐ Consulted an agency EEO counselor within the current OHR period on [DATE] ☐ Received exit letter on [DATE] ☐ Submitted the OHR intake questionnaire within 15 days after the exit letter. [OHR's current process page states a 180-calendar-day counselor period; confirm the live instructions before filing.]

Federal employee gate: ☐ Not a federal employee claim ☐ This matter is being handled through the separate federal-sector EEO process. [OHR's current filing page directs federal employees to EEOC.]

7. STATEMENT OF PARTICULARS

Provide a clear, chronological, factual narrative of the alleged discriminatory conduct. Use first person. Identify decisionmakers, dates, witnesses, comparators, and direct or circumstantial evidence of discriminatory animus.

A. Background.

I, [COMPLAINANT NAME], was [employed by / a tenant of / a customer of / a student at] Respondent [NAME] from [__/__/____] to [__/__/____] as a [POSITION / ROLE]. At all relevant times, I performed my duties competently and met or exceeded Respondent's legitimate expectations.

B. Membership in Protected Class.

I am a member of the following DCHRA-protected class(es): [LIST PROTECTED CLASSES]. [Briefly explain — e.g., "I am a Black woman of Haitian national origin, and I was visibly pregnant beginning in [MONTH/YEAR]."]

C. Adverse Action(s).

On or about [DATE], Respondent [describe specific adverse action — e.g., terminated my employment / refused to rent the apartment at [ADDRESS] / refused to serve me / denied me admission]. The adverse action was taken by [NAME OF DECISIONMAKER], who [describe communication — e.g., stated in writing / told me in a meeting / left a voicemail] that [stated reason or absence of reason].

D. Evidence of Discriminatory Animus.

The following facts demonstrate that the adverse action was motivated, at least in part, by my protected class:

1. Direct evidence (statements, slurs, written communications): [________________________________]
2. Comparator evidence (similarly situated persons outside my protected class who received more favorable treatment): [________________________________]
3. Departure from policy or practice: [________________________________]
4. Pretext (false or shifting reasons offered by Respondent): [________________________________]
5. Pattern or statistical evidence: [________________________________]
6. Temporal proximity to protected activity (retaliation only): [________________________________]

E. Protected Activity (Retaliation Only).

On [DATE], I engaged in protected activity by [describe — e.g., complaining to HR / filing an OHR or EEOC charge / participating in another person's investigation / requesting an accommodation]. Respondent thereafter, on [DATE], engaged in the adverse, coercive, threatening, retaliatory, or interfering conduct described above. The timing and additional facts above demonstrate causation.

F. Harm Suffered.

As a result of Respondent's unlawful conduct, I have suffered [lost wages and benefits in approximate amount $[AMOUNT]; emotional distress; humiliation; damage to my professional reputation; out-of-pocket medical/therapy expenses of approximately $[AMOUNT]; etc.].

8. WITNESSES AND COMPARATORS

Witnesses (persons with knowledge of the facts):

Comparators (persons outside Complainant's protected class treated more favorably):

9. DOCUMENTARY EVIDENCE

The following documents are attached or available upon request:

• ☐ Employment offer letter / contract
• ☐ Lease / rental application / housing communications
• ☐ Performance evaluations
• ☐ Disciplinary records
• ☐ Termination / eviction / denial letter
• ☐ Email / text / voicemail communications evidencing animus or adverse action
• ☐ Pay records / wage statements
• ☐ HR complaints / internal investigation records
• ☐ Medical or accommodation records [provide only as requested and after privacy/redaction review]
• ☐ Religious accommodation request and response
• ☐ ADA/disability accommodation request and response
• ☐ Witness statements / declarations
• ☐ Photographs / video / audio recordings
• ☐ Employee handbook / policies
• ☐ Comparator records (where lawfully obtained)
• ☐ EEOC charge (if dual-filed)
• ☐ Other: [________________________________]

10. DAMAGES AND RELIEF REQUESTED

I respectfully request resolution through OHR's statutory process and, if the Commission ultimately finds an unlawful discriminatory practice, the legally available relief supported by the selected claim and proof:

• ☐ Back pay (lost wages, bonuses, commissions, benefits)
• ☐ Reinstatement, hiring, upgrading, back pay, or other applicable make-whole relief
• ☐ Compensatory damages for proven harm (D.C. Code § 2-1403.13 states no numeric compensatory-damages cap)
• ☐ Reasonable attorneys' fees and costs (D.C. Code § 2-1403.13(a)(1)(E))
• ☐ Injunctive relief (cease-and-desist, training, policy reform, posting)
• ☐ Affirmative action including hiring, promotion, accommodation
• ☐ Civil penalties payable to the District's General Fund under the Commission remedy tiers (D.C. Code § 2-1403.13(a)(1)(E-i))
• ☐ Restoration of housing tenancy / refund of rental fees (housing)
• ☐ Restoration of access to public accommodation
• ☐ Restoration of educational opportunity
• ☐ Other: [________________________________]

11. ELECTION OF REMEDIES / DUAL FILING ACKNOWLEDGMENT

I acknowledge that I have been advised of the following:

• ☐ I understand that D.C. Code § 2-1403.16(c)-(d) permits a later private action after specified OHR dismissals or a timely written withdrawal. After a probable-cause finding, a non-residential-real-estate complainant generally must withdraw on or before the 30th day after the close of discovery. Suit then must be filed within 90 days after OHR serves its notice or within the remaining 2-year period, whichever is longer.
• ☐ [Housing/FHA only] I understand that a residential probable-cause charge follows the separate § 2-1403.05(f)-(g) election route: an eligible person elects within 20 days after service of the charge, gives certified-mail notice to the Director and all parties, and the Attorney General files the civil action for the aggrieved party, who may intervene.
• ☐ I understand that EEOC's general FEPA guidance describes dual filing only when the FEPA has a worksharing agreement and the allegation is covered by EEOC-enforced law. I will confirm the current agencies, filing arrangement, federal coverage, and federal deadline rather than assuming this OHR submission perfects every federal claim.
• ☐ I have considered, with counsel where applicable, whether to use OHR's administrative path or a direct private action in a court of competent jurisdiction under D.C. Code § 2-1403.16.
• ☐ I understand that a person maintaining a court action based on the same DCHRA act may not file the same complaint with OHR. D.C. Code § 2-1403.16(e).

Concurrent or Prior Filings:

• Have you filed a charge or complaint regarding this matter with any other agency? ☐ Yes ☐ No
• If yes, identify agency, date, and case number: [________________________________]
• Have you filed a lawsuit regarding this matter in any court? ☐ Yes ☐ No
• If yes, identify court, date, and case number: [________________________________]

12. VERIFICATION AND SIGNATURE

I, [COMPLAINANT NAME], certify that the factual information in this preparation worksheet and any attached narrative is true and complete to the best of my knowledge, information, and belief. I understand that I must review and sign OHR's current official questionnaire and any later official Charge of Discrimination as OHR directs.

Signature of Complainant: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

Official OHR questionnaire signed on: [__/__/____]

13. PRACTICE NOTES — DC OFFICE OF HUMAN RIGHTS

• Use OHR's official form. OHR currently directs complainants to submit the sphere-specific intake questionnaire. OHR assesses it and may later docket and serve the official Charge of Discrimination. This worksheet is an organizer or narrative attachment, not the official questionnaire.
• One-year filing deadline. D.C. Code § 2-1403.04(a) requires an OHR complaint within 1 year of the unlawful act or its discovery. The general DCHRA private-action period is 2 years. Calendar both and any shorter special procedure.
• D.C. government and federal employees. OHR's current process page states that D.C. government employees must consult an agency EEO counselor within 180 calendar days and submit the OHR intake questionnaire within 15 days of the exit letter. OHR's filing page directs federal employees to the federal EEOC process. Verify the live instructions before filing.
• Administrative-to-court route. Section 2-1403.16(c)-(d) preserves a private action after specified OHR dismissals or a timely written withdrawal. The post-probable-cause withdrawal route in subsection (d) excludes residential-real-estate/FHA complaints covered by § 2-1403.05. Calendar the applicable notice date and 90-day-or-remaining-period rule.
• Residential probable-cause route. A residential-real-estate or FHA election under § 2-1403.05(f)-(g) is due within 20 days after service of a probable-cause charge, requires certified-mail notice to the Director and parties, and results in an Attorney General civil action in which an aggrieved party may intervene.
• EEOC dual-filing gate. EEOC states that dual filing occurs when a FEPA has a worksharing agreement and the allegation is covered by EEOC-enforced law. Confirm the current D.C. arrangement and the exact federal statute and deadline; 29 C.F.R. § 1601.13 is not itself an EEOC-OHR worksharing agreement.
• Mandatory mediation. D.C. Code § 2-1403.04(c) requires mediation before OHR commences a full investigation. Parties have up to 45 days to mediate.
• Probable cause / conciliation / hearing. OHR investigates and determines probable cause. Under § 2-1403.06, probable-cause cases proceed to conciliation for up to 60 days; if no agreement is executed, OHR certifies the case to the Commission for public hearing. Residential election cases follow § 2-1403.05.
• Commission remedies. After a finding, the Commission may order appropriate affirmative relief, compensatory damages, attorneys' fees and costs, hearing costs, and statutory civil penalties payable to the General Fund. Section 2-1403.13 does not itself authorize punitive damages.
• Compensatory damages. Section 2-1403.13 authorizes compensatory damages without stating a numeric cap. Do not request punitive or multiplied damages in the administrative charge without separate current controlling authority.
• Individual respondent gate. Section 2-1402.62 prohibits aiding, abetting, inviting, compelling, or coercing a forbidden act. Name an individual only when the facts and the applicable provision support the theory; a title alone does not establish liability.
• Submission methods. Use the current official questionnaire. OHR's filing page lists [email protected], fax (202) 727-9589, and mail or in-person delivery at 441 4th Street NW, Suite 570N, Washington, DC 20001. An email without a completed complaint form is not accepted.
• Tolling. A timely OHR filing tolls the 2-year private-action period under D.C. Code § 2-1403.16(b)(2) until OHR serves a notice of right to file a civil action.
• Recent amendments. The Fairness in Human Rights Administration Amendment Act of 2024 created additional withdrawal and notice rights, enlarged the general private-action period to 2 years, changed the Commission fee provision to "attorneys' fees and costs," and expanded administrative remedies for claims against the District government. D.C. Law 26-55 makes the implemented overlay applicable as of October 1, 2025, except as otherwise provided.

14. SOURCES AND REFERENCES

• D.C. Code § 2-1401.03 (Exceptions) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1401.03
• D.C. Code § 2-1402.11 (Employment) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1402.11
• D.C. Code § 2-1402.21 (Housing) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1402.21
• D.C. Code § 2-1402.31 (Public accommodations) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1402.31
• D.C. Code § 2-1402.41 (Educational institutions) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1402.41
• D.C. Code § 2-1402.61 (Coercion or retaliation) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1402.61
• D.C. Code § 2-1402.62 (Aiding or abetting) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1402.62
• D.C. Code § 2-1403.04 (Filing of complaints; mediation) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1403.04
• D.C. Code § 2-1403.05 (Investigation) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1403.05
• D.C. Code § 2-1403.06 (Conciliation) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1403.06
• D.C. Code § 2-1403.06a (Notice of right to file civil action) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1403.06a
• D.C. Code § 2-1403.13 (Remedies) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1403.13
• D.C. Code § 2-1403.16 (Private cause of action) — https://code.dccouncil.gov/us/dc/council/code/sections/2-1403.16
• File a Discrimination Complaint (OHR) — https://ohr.dc.gov/service/file-discrimination-complaint
• OHR Complaint Process & Timeline — https://ohr.dc.gov/page/complaint-process-timeline
• D.C. Law 25-300, Fairness in Human Rights Administration Amendment Act of 2024 — https://code.dccouncil.gov/us/dc/council/laws/25-300
• D.C. Law 26-55 — https://code.dccouncil.gov/us/dc/council/laws/26-55
• EEOC — FEPAs and Dual Filing — https://www.eeoc.gov/fair-employment-practices-agencies-fepas-and-dual-filing
• 29 C.F.R. § 1601.13 — https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XIV/part-1601/subpart-B/section-1601.13

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in the District of Columbia must review and customize this document before submission. OHR procedures, regulations, and forms are subject to change; verify all current requirements at ohr.dc.gov before filing.