National Office for Victims - Victim Complaint Form

DOC (671 Kb)

Complaint submitted against the National Office for Victims at Public Safety Canada pursuant to subsection 25(1) of the Canadian Victims Bill of Rights

INSTRUCTIONS

Under the Canadian Victims Bill of Rights (CVBR), victims have a right to information, participation, protection and to seek restitution. Victim is defined as an individual who has suffered physical or emotional harm, property damage or economic loss as a result of the commission or alleged commission of a criminal offence in Canada.

The National Office for Victims at Public Safety Canada has a responsibility to provide general information to victims of crime about federal corrections issues, as well as to make direct referrals to the Correctional Service of Canada and the Parole Board of Canada for victims of federal offenders who wish to register to receive specific information about the offender who harmed them. If you feel as though the National Office for Victims did not provide you with this information or the referral you requested, you may submit a complaint for review.

A national toll-free phone number (1-866-525-0554) is available for victims to inquire about the victim complaint process or to ask specific questions about complaints they have filed. A victim who wishes to withdraw a complaint may do so by notifying the National Office for Victims in writing.

PRIVACY STATEMENT NOTICE

The information provided in this form is collected for Public Safety Canada’s CVBR complaints resolution mechanism for the purpose of addressing a complaint. If the information provided on this form is incomplete, it may be determined that your complaint does not meet the basic criteria of the CVBR.  All personal information provided in this document will be stored, protected, used, and disclosed in accordance with the Privacy Act.

If you have a privacy concern and are not satisfied with Public Safety’s response to your concern, you may wish to contact the Office of the Privacy Commissioner of Canada by e-mail at: info@priv.gc.ca or by telephone at
1-800-282-1376.

PLEASE TYPE OR PRINT LEGIBLY

PART A – VICTIM INFORMATION

Last Name

First Name

Address (Number, street, apartment unit)

City, Province

Country

Postal Code

Email Address

Daytime Phone Number

Can we email you at this email address with details about the investigation into your complaint?
□ Yes               □ No

Can we call you at this phone number to discuss the investigation into your complaint ? □ Yes         □ No

If yes, may we leave a message? □ Yes            □ No

 

 

Are you a Canadian citizen □
      OR     permanent resident □ ?

Are you currently present in Canada? 
        □ Yes         □ No

PART B – STATEMENT OF COMPLAINT (USE ADDITIONAL SHEETS IF NECESSARY AND ATTACH ANY RELEVANT SUPPORTING DOCUMENTATION THAT YOU WOULD LIKE TO HAVE CONSIDERED WHEN REVIEWING YOUR COMPLAINT)

 

 

 

 

 

HOW DO YOU THINK THIS COMPLAINT CAN BE RESOLVED?

 

 

 

 

PART C – SHARING OF PERSONAL INFORMATION BETWEEN DEPARTMENTS AND AGENCIES OF THE GOVERNMENT OF CANADA

If, after an assessment by Public Safety Canada, it is determined that this complaint falls under the mandate of another Government of Canada department or agency with a CVBR complaints resolution mechanism, I consent to Public Safety Canada sharing this complaint form and its attachments with the applicable Government of Canada department or agency.

□ Yes                   □ No

If you choose not to consent to the sharing of your information, Public Safety Canada will advise you in writing if your complaint does not fall within their mandate. You will be responsible for resubmitting your complaint to the relevant department or agency.

PART D – SIGNATURE OF COMPLAINANT

I certify that the information given on this form and its attachments is correct and complete.

Signature

Date (YYYY-MM-DD)

Once completed, please send the form to:

Date modified: