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Sample UCP Complaints Log (for online FPM reviews)

Sample UCP Complaint Case Log

Sample Uniform Complaint Case Log for UCP 3 (for Online FPM Reviews)

School Year:

Name of LEA
Phone number of Contact Person

Evidence of proper implementation of the investigation process [Provide the following information on at least three cases]

Complaints in accordance with CCR, Title 5, Section 4610(b). Upload a completed log in CAIS, at any time during the upload period and prior to the last day of the review. Districts are not required to upload complaint documents in CAIS, as part of the self-certification. LEAs are not required to use this sample.

Please see additional instructions for this process on the “LEA Self-Certification Form and Instructions for Completion of an Online Review for UCP 3.”

January 2012

Questions:   Categorical Programs Complaints Management Office| 916-319-0929
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