Rider Complaint Form
Federal Transit Administration
Office of Civil Rights
Complaint Form
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The Federal Transit Administration (FTA) Office of Civil Rights is responsible for civil rights compliance and monitoring of public transportation, which includes ensuring that providers properly implement Title II of the Americans with Disabilities Act of 1990 (the ADA), the Department of Transportation (DOT) ADA regulations, and Section 504 of the Rehabilitation Act of 1973. In the FTA complaint investigation process, we analyze the complainant's allegations for possible ADA deficiencies by the transit provider. If deficiencies are identified they are presented to the transit provider and assistance is offered to correct the inadequacies within a predetermined timeframe. FTA also may refer the matter to the U.S. Department of Justice for enforcement. Section I Name:_____________________________________________ Address:___________________________________________ ___________________________________________ Telephone Numbers: (Home)_________________________ (Work)__________________________ Electronic Mail Address:__________________________________ Accessible Format Requirements? Large Print _______ Audio tape _____ TDD ___________ Other________________________________________ |
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Section II Are you filing this complaint on your own behalf? Yes ____ No ____ [If you answered "yes" to this question, go to Section III.] If not, please supply the name and relationship of the person for whom you are complaining: _________________________________________________ Please explain why you have filed for a third party. ___________________________ ____________________________________________________________________ Please confirm that you have obtained the permission of the aggrieved party if you are filing Yes ____ No ____ |
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Section III Have you previously filed an ADA complaint with FTA? Yes____ No___ If yes, what was your FTA Complaint Number? ____________________ [Note: This information is needed for administrative purposes; we will assign the same complaint Have you filed this complaint with any of the following agencies? Transit Provider _____ Department of Transportation ____ Department of Justice_____ Equal Employment Opportunity Commission _____ Other _____________________________________________ Have you filed a lawsuit regarding this complaint? Yes_____ No____ If yes, please provide a copy of the complaint form. [Note: This above information is helpful for administrative tracking purposes.] |
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Section IV Name of public transit provider complaint is against: ____________________________________________________________________ Contact person: _________________________ Title: _________________________ Telephone number: _____________________________________________________ On separate sheets, please describe your complaint. You should include |
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Section V May we release a copy of your complaint to the transit provider? Yes ____ No ____ May we release your identity to the transit provider? Yes ____ No ____ Please sign here: _____________________________________________ Date: ______________ [Note - We cannot accept your complaint without a signature.] |
Please mail your completed form to:
Director, FTA Office of Civil Rights
East Building – 5th Floor, TCR
1200 New Jersey Ave., SE
Washington, DC 20590
You may also leave a message at our toll free FTA ADA Assistance Line, 1-888-446-4511 (Voice) or through the Federal Information Relay Service, 1-800-877-8339. We can be reached by electronic mail at: FTA.ADAAssistance@dot.gov. The FTA Web Page can be found at [http://www.fta.dot.gov].
