New York State and City Human Rights Agency Charge (DHR / NYCCHR / EEOC Cross-Filed)

NEW YORK STATE DIVISION OF HUMAN RIGHTS — VERIFIED COMPLAINT (NYSHRL)

TABLE OF CONTENTS

1. Caption and Filing Cover
2. Complainant Information
3. Respondent Information
4. Cross-Filing Election (EEOC / NYCCHR)
5. Jurisdiction and Coverage
6. Statute of Limitations Statement
7. Protected Class Basis
8. Statement of Particulars
9. Adverse Actions
10. Retaliation
11. Witnesses
12. Documentary Evidence
13. Damages and Relief Requested
14. Reasonable Accommodation Requests (if applicable)
15. Prior Filings and Election of Remedies
16. Verification
17. Service of Complaint
18. Filing Method and Submission
19. Cover Letter / Transmittal
20. Post-Filing Procedure (DHR Process Timeline)
21. Strategic and Practice Notes
22. NYCCHR Filing Instructions (Alternative Forum)
23. Sources and References

1. CAPTION AND FILING COVER

STATE OF NEW YORK

EXECUTIVE DEPARTMENT — DIVISION OF HUMAN RIGHTS

ONE FORDHAM PLAZA, 4TH FLOOR, BRONX, NY 10458

DHR Case No. [________________________________]

VERIFIED COMPLAINT OF UNLAWFUL DISCRIMINATORY PRACTICE

(Filed under the New York State Human Rights Law, N.Y. Exec. Law § 290 et seq., and Cross-Filed with the U.S. Equal Employment Opportunity Commission)

2. COMPLAINANT INFORMATION

3. RESPONDENT INFORMATION

4. CROSS-FILING ELECTION (EEOC / NYCCHR)

☐ Cross-file this complaint with the U.S. Equal Employment Opportunity Commission (EEOC) under the DHR-EEOC work-sharing agreement to preserve federal claims under Title VII (42 U.S.C. § 2000e-5), the ADEA (29 U.S.C. § 626(d)), the ADA Title I (42 U.S.C. § 12117), and/or GINA.

☐ Cross-file this complaint with the New York City Commission on Human Rights (NYCCHR) to preserve NYCHRL administrative claims (only available for conduct occurring in NYC's five boroughs).

☐ DO NOT cross-file. Complainant elects to proceed solely under DHR/NYSHRL.

5. JURISDICTION AND COVERAGE

5.1. The conduct complained of occurred within the State of New York at [ADDRESS / LOCATION / FACILITY], in [COUNTY].

5.2. Respondent is subject to the NYSHRL because: ☐ Respondent is an employer with one or more employees (Exec. Law § 292(5)). ☐ Respondent is a place of public accommodation (Exec. Law § 292(9)). ☐ Respondent is a housing provider (Exec. Law § 292(2-a)). ☐ Other coverage basis: [_______________].

5.3. Complainant is an aggrieved person within the meaning of the NYSHRL because: [describe — e.g., "I was employed by Respondent from [date] to [date] as a [position]"; "I am a tenant of Respondent's building"; "I was a customer denied service"].

6. STATUTE OF LIMITATIONS STATEMENT

6.1. The most recent unlawful discriminatory act occurred on [DATE].

6.2. ☐ The accrual date is on or after February 15, 2024, and this complaint is filed within THREE (3) YEARS pursuant to N.Y. Exec. Law § 297.5, as amended by ch. 567 of the Laws of 2023 (effective 2/15/2024).

6.3. ☐ The accrual date is before February 15, 2024, but the complaint involves SEXUAL HARASSMENT in employment, and this complaint is filed within THREE (3) YEARS pursuant to the 2019 amendment effective 8/12/2020.

6.4. ☐ The accrual date is before February 15, 2024, and the complaint does NOT involve sexual harassment; this complaint is filed within ONE (1) YEAR per the prior version of N.Y. Exec. Law § 297.5.

6.5. ☐ Continuing-violation doctrine applies — the unlawful conduct continues into the limitations period and is part of a single hostile work environment, citing National Railroad Passenger Corp. v. Morgan, 536 U.S. 101 (2002), and Cornwell v. Robinson, 23 F.3d 694 (2d Cir. 1994).

7. PROTECTED CLASS BASIS

Complainant alleges discrimination based on the following protected classes recognized under N.Y. Exec. Law § 296:

☐ Age (18+ in employment; all in housing/public accommodation)

☐ Race

☐ Creed / religion

☐ Color

☐ National origin

☐ Citizenship or immigration status

☐ Sexual orientation

☐ Gender identity or expression

☐ Sex (including pregnancy and pregnancy-related conditions)

☐ Marital status

☐ Familial status (housing)

☐ Military status

☐ Disability (physical, mental, or medical)

☐ Predisposing genetic characteristics

☐ Domestic violence victim status

☐ Status as a victim of human trafficking

☐ Arrest record (in employment, with limitations)

☐ Conviction record (subject to Article 23-A analysis)

☐ Lawful source of income (housing)

☐ Reproductive health decision making

☐ Retaliation for opposing prohibited practice / participating in proceeding

☐ Aiding and abetting (against individual respondent)

☐ Other: [_______________]

8. STATEMENT OF PARTICULARS

8.1. Complainant was employed by Respondent [EMPLOYER] from [START DATE] to [END DATE / present] as a [POSITION TITLE], performing duties including [DUTIES]. Complainant met or exceeded all legitimate performance expectations.

8.2. Complainant is a member of the protected class(es) marked in Section 7. [Provide identifying particulars as relevant — e.g., "I am African American," "I have multiple sclerosis," "I am pregnant," "I am over the age of 40," "I am a transgender woman," etc.]

8.3. CHRONOLOGICAL NARRATIVE OF DISCRIMINATORY CONDUCT. The following acts of discrimination, harassment, and/or retaliation occurred:

8.3.1. On or about [DATE], [describe specific incident: who did what, said what, in whose presence, and how it related to Complainant's protected class].

8.3.2. On or about [DATE], [second incident].

8.3.3. On or about [DATE], [third incident].

8.3.4. [Continue chronologically — DHR investigators rely heavily on date-anchored particulars to assess probable cause.]

8.4. Similarly situated employees outside Complainant's protected class were treated more favorably. Specifically: [name comparator(s); describe their protected-class status; describe the more favorable treatment].

8.5. Respondent's stated reasons for the adverse treatment of Complainant — including [STATED REASONS] — are pretextual because [explain why: e.g., shifting reasons; reasons not applied to comparators; reasons contradicted by documentary evidence].

9. ADVERSE ACTIONS

Complainant suffered the following adverse actions on the basis of the protected class(es) identified in Section 7:

☐ Termination on [DATE]

☐ Demotion on [DATE]

☐ Failure to hire on [DATE]

☐ Failure to promote on [DATE]

☐ Discriminatory discipline on [DATE]

☐ Reduction in hours / pay on [DATE]

☐ Constructive discharge effective [DATE]

☐ Hostile work environment beginning on or about [DATE]

☐ Denial of reasonable accommodation on [DATE]

☐ Denial of leave on [DATE]

☐ Denial of housing / housing-related benefits on [DATE]

☐ Denial of public accommodation / service on [DATE]

☐ Other: [_______________]

10. RETALIATION

10.1. Complainant engaged in protected activity by [describe — e.g., "complaining about [DISCRIMINATORY CONDUCT] to HR on [DATE]"; "filing a prior DHR/EEOC charge on [DATE]"; "participating as a witness in [INVESTIGATION]"; "requesting reasonable accommodation on [DATE]"].

10.2. Respondent learned of Complainant's protected activity on or about [DATE].

10.3. Within [TIME] thereafter, Respondent took the following adverse action(s) against Complainant: [DESCRIBE].

10.4. The retaliatory motive is shown by [temporal proximity / direct evidence / shifting explanations / disparate treatment of similarly situated non-complainants].

11. WITNESSES

12. DOCUMENTARY EVIDENCE

Complainant submits or will produce the following documentary evidence:

☐ Personnel file / employment records

☐ Written discrimination policies / handbooks

☐ Internal complaints (with dates and recipients)

☐ HR investigation records / outcomes

☐ Emails, text messages, voicemails, or other electronic communications

☐ Performance evaluations and disciplinary records

☐ Pay stubs / W-2s / earnings statements (back-pay calculation)

☐ Medical records (for disability claims and emotional distress)

☐ Comparator evidence (treatment of other employees)

☐ Witness statements / declarations

☐ Audio / video recordings

☐ Other: [_______________]

13. DAMAGES AND RELIEF REQUESTED

Complainant requests the following relief from DHR pursuant to N.Y. Exec. Law § 297(4)(c):

☐ Order that Respondent cease and desist from the unlawful discriminatory practice

☐ Reinstatement to former position

☐ Back pay (lost wages and benefits)

☐ Front pay (where reinstatement is infeasible)

☐ Compensatory damages for emotional distress, mental anguish, humiliation, and loss of enjoyment of life (UNCAPPED under NYSHRL)

☐ Punitive damages (employment and housing cases, post-2019 amendments)

☐ Civil fines and penalties payable to the State (Exec. Law § 297(4)(c)(vi); up to $50,000 per violation, $100,000 for willful, wanton, or malicious violations)

☐ Reasonable attorney fees pursuant to N.Y. Exec. Law § 297(10)

☐ Order expunging adverse employment records

☐ Order requiring training, posting of notices, and policy revision

☐ Other equitable relief: [_______________]

14. REASONABLE ACCOMMODATION REQUESTS (IF APPLICABLE)

14.1. Complainant requested the following reasonable accommodation(s) from Respondent: [DESCRIBE — e.g., modified schedule, ergonomic equipment, leave, reassignment, religious accommodation, lactation accommodation, pregnancy accommodation].

14.2. The request was made on [DATE] to [NAME / TITLE] in the form of [written / verbal / both].

14.3. Respondent [denied / failed to engage in interactive process / granted but in inadequate form / retaliated against] the request, in violation of N.Y. Exec. Law § 296(3) (disability and pregnancy-related accommodation) and § 296(10) (religious accommodation).

15. PRIOR FILINGS AND ELECTION OF REMEDIES

15.1. ☐ Complainant has NOT filed any prior charge or civil action concerning the conduct complained of herein.

15.2. ☐ Complainant has filed the following prior agency charge(s) or civil action(s):

15.3. By filing this Complaint, Complainant understands and acknowledges that, pursuant to N.Y. Exec. Law § 297(9), the filing of this charge with DHR may bar Complainant from filing a subsequent civil action in court on the same facts, except where DHR dismisses the complaint for administrative convenience, untimeliness, or upon Complainant's request to annul election before a hearing.

16. VERIFICATION

STATE OF NEW YORK

COUNTY OF [________________________________]

I, [COMPLAINANT NAME], being duly sworn, depose and say: I am the Complainant herein; I have read the foregoing Verified Complaint and know the contents thereof; the same is true to my own knowledge, except as to those matters therein stated to be alleged on information and belief, and as to those matters I believe them to be true. I understand that this Complaint will be served upon Respondent and that I am subject to penalty for false statements pursuant to N.Y. Penal Law § 210.45.

[________________________________]

[COMPLAINANT NAME]

Sworn to before me this [____] day of [_______________], 20[____].

[________________________________]

Notary Public

(My Commission Expires: [_______________])

17. SERVICE OF COMPLAINT

DHR will serve a copy of this Complaint on Respondent within five (5) business days of acceptance pursuant to 9 NYCRR § 465.4. Complainant requests that DHR serve at the following addresses:

• Respondent [EMPLOYER]: [ADDRESS]
• Individual Respondent [NAME]: [ADDRESS]

18. FILING METHOD AND SUBMISSION

Effective November 14, 2025, DHR accepts new discrimination reports only through:

Mail, email, and in-person hand delivery are NO LONGER accepted for initial intake. After the discrimination report is submitted, the DHR Intake Unit will review and either (a) draft a formal complaint for Complainant's signature or (b) issue a rejection letter.

DHR Central Office (Bronx):

Regional Offices (consult dhr.ny.gov/contact-us for current listings):

• Brooklyn: 55 Hanson Place, Room 304, Brooklyn, NY 11217 — (718) 722-2854
• Manhattan / Harlem: see dhr.ny.gov/location/manhattan
• Long Island, Buffalo, Rochester, Syracuse, Albany, Binghamton, Peekskill, Plattsburgh, Lower Hudson Valley — see dhr.ny.gov/contact-us

19. COVER LETTER / TRANSMITTAL

Date: [DATE]

New York State Division of Human Rights

One Fordham Plaza, 4th Floor

Bronx, NY 10458

Re: [COMPLAINANT NAME] v. [RESPONDENT NAME] — Verified Complaint

Dear Intake Unit:

Enclosed for filing please find the Verified Complaint of Unlawful Discriminatory Practice on behalf of Complainant [NAME], alleging discrimination, harassment, and/or retaliation under N.Y. Exec. Law § 296 in connection with conduct occurring at [LOCATION]. The most recent unlawful act occurred on [DATE], well within the three-year limitations period prescribed by N.Y. Exec. Law § 297.5.

Complainant requests that this Complaint be:

☐ Investigated under the Division's standard procedures (9 NYCRR Part 465).

☐ Cross-filed with the U.S. Equal Employment Opportunity Commission under the DHR-EEOC work-sharing agreement.

☐ Cross-filed with the New York City Commission on Human Rights pursuant to NYC Admin. Code § 8-109.

Complainant is represented by undersigned counsel and consents to electronic communications at the address indicated.

Respectfully submitted,

[________________________________]

[ATTORNEY NAME]

Counsel for Complainant

[FIRM / ADDRESS / PHONE / EMAIL]

20. POST-FILING PROCEDURE (DHR PROCESS TIMELINE)

21. STRATEGIC AND PRACTICE NOTES

• Three-year SOL — verify accrual. Effective 2/15/2024, all NYSHRL discrimination claims (employment, housing, public accommodation, education, credit) carry a three-year administrative window under N.Y. Exec. Law § 297.5. The amendment is prospective; claims accruing earlier remain at one year (three for sexual harassment).
• Election of remedies — strategic decision. Filing with DHR generally bars later court action. To preserve a court action, consider filing solely with the EEOC; cross-filed EEOC charges have not consistently been treated as election under recent S.D.N.Y. dual-filing decisions. Counsel must weigh administrative remedies (free, no court costs, agency-driven investigation) against court remedies (jury trial, broad discovery, attorney-fee leverage).
• NYCCHR alternative. For NYC-based conduct, NYCCHR offers MORE favorable substantive standards under the NYCHRL liberal-construction mandate (NYC Admin. Code § 8-130), codifying Williams v. NYC Housing Auth., 61 A.D.3d 62 (1st Dep't 2009). Plaintiffs need only show "less-well-than-others" treatment — a markedly lower threshold than NYSHRL or Title VII. NYCCHR filing deadlines: 1 year generally; 3 years for gender-based harassment.
• EEOC work-share. A DHR or NYCCHR charge cross-filed with the EEOC is treated by the EEOC as a federal charge for limitations purposes (300-day deadline for Title VII / ADEA / ADA Title I, because NY is a deferral state).
• DHR damages — uncapped. Compensatory damages for emotional distress are uncapped. Punitive damages were authorized for employment and housing cases by the 2019 amendments (Exec. Law § 297(4)(c)(iv)). DHR may also impose civil fines payable to the State up to $50,000 (or $100,000 for willful, wanton, or malicious violations).
• Attorney fees. N.Y. Exec. Law § 297(10) authorizes prevailing-party attorney fees in employment and housing cases. NYC Admin. Code § 8-502(g) authorizes fees in NYCCHR cases.
• Mandatory NDA prohibition. N.Y. Gen. Oblig. Law § 5-336 (effective 11/17/2023) prohibits enforcement of pre-claim non-disclosure provisions covering discrimination, harassment, or retaliation; review prior NDAs and severance agreements before filing.
• Continuing-violation doctrine. Hostile-work-environment claims may reach back beyond the limitations period under National R.R. Passenger Corp. v. Morgan, 536 U.S. 101 (2002), so long as one component act occurs within the period.
• Pro-se filing. Complainants may file without counsel. DHR provides intake assistance at no charge; the Call Center has multilingual support.

22. NYCCHR FILING INSTRUCTIONS (ALTERNATIVE FORUM)

For conduct occurring within New York City's five boroughs (Manhattan, Brooklyn, Queens, Bronx, Staten Island), Complainants may alternatively file with the New York City Commission on Human Rights ("NYCCHR") under the NYCHRL (NYC Admin. Code § 8-101 et seq.), which provides MORE protective substantive standards under the liberal-construction mandate (§ 8-130) codified in Williams v. NYC Housing Auth., 61 A.D.3d 62 (1st Dep't 2009).

To file with NYCCHR, retitle this Complaint "Verified Complaint Filed Under the New York City Human Rights Law," substitute the NYCCHR caption, and invoke NYC Admin. Code §§ 8-107, 8-109, 8-130, and 8-502 in lieu of the NYSHRL provisions. Liberal-construction language and "less-well-than-others" causation should be expressly pleaded.

23. SOURCES AND REFERENCES

• NYSHRL — N.Y. Exec. Law § 290 et seq. — https://www.nysenate.gov/legislation/laws/EXC/A15
• N.Y. Exec. Law § 296 — https://www.nysenate.gov/legislation/laws/EXC/296
• N.Y. Exec. Law § 297 — https://www.nysenate.gov/legislation/laws/EXC/297
• NYS Division of Human Rights — Homepage — https://dhr.ny.gov/
• DHR — Report Discrimination — https://dhr.ny.gov/report
• DHR — Online Complaint Form — https://webapps.dhr.ny.gov/discrimination-report
• DHR — Contact Us — https://dhr.ny.gov/contact-us
• DHR — 2025 Filing Process Changes — https://dhr.ny.gov/notice-change-filing-2025
• DHR — FAQ — https://dhr.ny.gov/frequently-asked-questions
• DHR — Governor Hochul 3-Year SOL Announcement — https://dhr.ny.gov/news/governor-hochul-announces-new-statute-limitations-unlawful-discrimination
• 9 NYCRR Part 465 (DHR Rules of Practice) — https://govt.westlaw.com/nycrr/Browse/Home/NewYork/NewYorkCodesRulesandRegulations
• NYC Admin. Code Title 8 (Civil Rights) — https://codelibrary.amlegal.com/codes/newyorkcity/latest/NYCadmin/0-0-0-219879
• NYC Commission on Human Rights — https://www.nyc.gov/site/cchr/index.page
• NYCCHR — Complaint Process — https://www.nyc.gov/site/cchr/enforcement/complaint-process.page
• NYCCHR — Steps in the Complaint Process — https://www.nyc.gov/site/cchr/enforcement/steps-in-the-complaint-process.page
• EEOC — Filing a Charge — https://www.eeoc.gov/filing-charge-discrimination
• Williams v. New York City Housing Authority, 61 A.D.3d 62 (1st Dep't 2009) — https://www.nycourts.gov/reporter/3dseries/2009/2009_00440.htm
• National R.R. Passenger Corp. v. Morgan, 536 U.S. 101 (2002)
• Mihalik v. Credit Agricole Cheuvreux N. Am., Inc., 715 F.3d 102 (2d Cir. 2013)

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney admitted to practice in New York must review and customize this document before filing. Filing an administrative charge has significant legal and strategic consequences, including potential election-of-remedies bar to court action. Laws, citations, and agency procedures change frequently; verify all authorities and procedures before use.