BEFORE THE [NAME OF STATE OFFICE THAT DECIDES HAVA COMPLAINTS, e.g., Secretary of State, State Board of Elections]
VERIFIED COMPLAINT UNDER SECTION 402 OF THE HELP AMERICA VOTE ACT OF 2002, 52 U.S.C. 21112, AND [STATE RULE CITATION]
Alleged violation of HAVA Title III, Section [301 / 302 / 303 / 304], 52 U.S.C. [21081 / 21082 / 21083 / 21083a]([subsection])
Election for federal office concerned: [name and date of election, e.g., General Election, November 3, 2026]
1. Complainant
[Full legal name]
[Street address, city, state, ZIP]
[Telephone] | [Email]
[If true: I am a registered voter in [County/Town], [State].]
Note: HAVA lets "any person" file (52 U.S.C. 21112(a)(2)(B)), but some states limit who may file. Check your state.
2. Respondent
[Name and official title of the state or local election official or office responsible for the requirement], in [his/her/its] official capacity
[Address]
Note: Name the official or office that has the legal duty. Complaints have been dismissed or returned because they named a body that is not an "election authority" (Michigan, Jan. 17, 2024), named the agency that decides the complaints (Wisconsin and Hawaii), or named the wrong level of government (Minnesota, 2022). Some states require you to send the respondent a copy (for example, Illinois 26 Ill. Adm. Code 150.25).
3. Nature of the complaint
This complaint concerns one issue: [state the issue in one sentence, e.g., "No voting system accessible to voters with disabilities was available and working at [polling place] on [date]."]
I believe this violation [has occurred / is occurring / is about to occur] (52 U.S.C. 21112(a)(2)(B)).
This is not an election contest. I do not ask to change any election result and I do not seek money damages. I ask for the appropriate remedy under 52 U.S.C. 21112(a)(2)(F).
Note: Use one complaint per issue. If you have several unrelated problems, file separate complaints.
4. Title III requirement
Section [number] of HAVA, 52 U.S.C. [section and subsection], requires: "[quote the exact words of the requirement]."
Note: Title III covers voting systems (sec. 301), provisional ballots and polling-place information (sec. 302), the statewide voter list and ID for some first-time mail registrants (sec. 303), and congressional observers (sec. 304). Problems under other laws, such as state-only rules, the National Voter Registration Act, or a state's HAVA plan, are usually dismissed from this procedure.
5. Facts
5.1 On [date], at about [time], I was at [polling place or office name and street address], [precinct, town, county].
5.2 I saw or heard the following: [describe exactly what happened, in order, in plain words].
5.3 The election officials involved were [names and titles, if known]. I asked [what you asked]. I was told [exact words, as best you remember].
5.4 Other people who saw this: [names and contact information of witnesses, if they agree].
5.5 Facts I know from other sources: [describe, and name the source, such as a public record or notice]. Facts stated on information and belief are identified as such.
Note: Be specific. "Poll workers were unhelpful" is weak. "At 7:40 a.m. on November 3, 2026, at Lincoln School, 12 Main St., the clerk told me the accessible machine was 'not set up today', and no other accessible machine was offered" is strong. Several New York determinations that found violations rested on exactly this kind of detail.
6. Why these facts violate Title III
[Explain in two or three sentences how the facts in Section 5 fail to meet the requirement quoted in Section 4.]
7. Timeliness
The events described occurred on [date]. This complaint is filed on [date], which is within [number] days. [State rule] sets a filing deadline of [number] days. [If no state deadline: The state rule sets no filing deadline.]
[If the violation is continuing or about to occur, state the specific, current facts that show it, such as a written procedure, an announced plan, or equipment decisions for an upcoming election.]
Note: Federal law sets no filing deadline, but 28 jurisdictions set one (as short as 10 days in Virginia). File as soon as you can. New York dismissed a complaint about past elections as untimely even though it was framed as a continuing violation (CMP 26-01, June 3, 2026).
8. Requests
8.1 Please accept this complaint and state in writing the date on which it was received and filed.
8.2 Hearing. I request a hearing on the record under 52 U.S.C. 21112(a)(2)(E) [and state rule]. I ask to present the following witnesses: [names].
8.3 Deadline. Please make a final determination within 90 days of filing (52 U.S.C. 21112(a)(2)(H)). I do not consent to any extension of the 90-day period unless I agree in writing. If no final determination is made within 90 days, I ask that the complaint be resolved within 60 days under alternative dispute resolution, using the record of these proceedings (52 U.S.C. 21112(a)(2)(I)).
8.4 Records. Please preserve all records relating to this complaint, including [list: logs, equipment records, notices, correspondence], and keep election records for the period required by 52 U.S.C. 20701 where it applies.
8.5 Remedy. I ask the State to [describe a remedy the State can actually order, such as placing a working accessible voting system at the polling place, issuing training directives, correcting a procedure, or correcting a record].
8.6 [If an election is near:] I ask for expedited consideration because the next election for federal office is on [date].
8.7 If the State finds no violation, I ask that it dismiss the complaint and publish the results, as 52 U.S.C. 21112(a)(2)(G) requires.
9. Exhibits
Exhibit A: [e.g., photo of posted notice, where lawful]
Exhibit B: [e.g., copy of public-records request and response]
Exhibit C: [e.g., signed witness statement]
10. Verification and signature
I, [full name], swear or affirm under penalty of perjury that I have read this complaint and that the facts stated in it are true to the best of my knowledge, information and belief. Facts stated on information and belief are identified as such, with their source.
Signature: ______________________________ Date: ______________
Printed name: [full name]
Notary acknowledgment
State of ____________________ County of ____________________
Subscribed and sworn to (or affirmed) before me on ______________ (date) by ______________________ (name of complainant), proved to me on the basis of satisfactory evidence to be the person who appeared before me.
Notary signature: ______________________________
Printed name: ______________________ My commission expires: ______________ [Seal]
Note: HAVA requires the complaint to be "in writing and notarized, and signed and sworn" (52 U.S.C. 21112(a)(2)(C)). Use your state's notary wording if its form has one. Missouri requires a notary commissioned in Missouri.