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Instructions for Making a Request
Instructions for Making a Request:
This application allows you to initiate contact with MDCR to request program services.
Answering Questions:
You must respond to ALL questions marked by an asterisk (*) unless instructed otherwise.
Give complete request information to ensure a clear understanding of the request.
Submitting the Request Form:
When the system informs you to review the information that you have entered, select the "Submit" button after review is completed to submit your request.
If you exit before you select the "Submit" button, all information you have entered will be lost. Any notfications being sent by the system will be canceled.
After clicking the "Submit" button, wait for a confirmation page containing your confirmation number. Your request has not been accepted until you see the confirmation page.
Print the confirmation page or write down the confirmation number. Your confirmation number will be used to reference your request.
A MDCR Customer Service Representative will contact you to discuss your concern in detail.
Additional Notes:
Privacy: The information you provide to the Michigan Department of Civil Rights concerning your request for program services is confidential and will be used only by public officials performing their duties.
FOIA: The information you provide to the Michigan Department of Civil Rights concerning your request for program services is subject to the Freedom of Information Act (FOIA).
If you do not hear from a customer service representative within three (3) business days, please contact our Intake Unit at 1-800-482-3604 to protect the timeliness of your filing rights.
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