Application Form Disability And Communication Access Board

This application form shall be completed by the person,

b) All documents shall be written in black ink,

agency or department for whom the request is intended.

typewritten, or printed legibly on paper no larger

The three request types are: 1) site specific alternate

than 8-1/2” x 14" except plans, maps, etc., may be

designs, 2) interpretive opinions, and 3) petition for adoption,

larger, folded to the required size.

amendment or repeal of design specifications. Instructions

The applicant is responsible for all arrangements for

for completing this request application form are provided

the public hearing (location, date, time) and

below.

publishing the legal notice. Staff will review, and if

To speed the processing of your request, please answer

acceptable, return the approved legal notice to the

completely and accurately all applicable questions on this

applicant to be printed. A minimum of twenty (20)

request application form. Photocopies of the form are

days public notice is required.

acceptable.

d) The Applicant is responsible for placing the legal

The Disability and Communication Access Board (DCAB)

notice

and

obtaining

affidavit

for

DCAB

staff will receive, review, date-stamp and assign a docket

specifying the date(s) the notice will appear in the

number to all applications. A final decision will be made at a

community's general circulation newspaper.

public hearing. A copy of the DCAB decision will be mailed

to the applicant and other interested parties.

LEGAL NOTICE SAMPLE: Substitute site specific and request

information in the underlined sections and submit to DCAB for

INSTRUCTIONS

approval prior to publication.

Fill in DATE of request.

Complete APPLICANT INFORMATION.

NOTICE OF PUBLIC HEARING

a) Requester's Company or Agency/Department and

DISABILITY AND COMMUNICATION ACCESS BOARD

Mailing Address

DOCKET (NUMBER):

b) Contact Person's Name and Title

(PROJECT TITLE) SITE SPECIFIC ALTERNATE DESIGN

Requester's Telephone and Facsimile Number

Complete REQUEST INFORMATION.

NOTICE IS HEREBY GIVEN of a public hearing to be held

a) Indicate the type of request.

by the State of Hawaii Disability and Communication Access

1) Site Specific Alternate Design (SSAD) means to

Board:

grant relief from specific requirements of HRS

§103-50, when the SSAD will ensure an

DATE:

(DATE)

alternate design that provides equal or greater

PLACE:

(LOCATION)

access for persons with disabilities. Complete

(ADDRESS)

steps 4, 5, and 6.

(CITY, STATE, ZIP)

2) Interpretive Opinion is a determination to the

TIME:

(START) TO

(END)

applicability of any provision administered by, or

of any rule, order or design specification of the

So that all interested persons shall be afforded a

Disability and Communication Access Board.

reasonable opportunity to be heard to consider under §103-

Complete step 4 only.

50, Hawaii Revised Statutes, the following:

3) Design Specifications are developed to achieve

accessibility guidelines for areas that are not

(PROJECT TITLE)

SITE SPECIFIC

cur-rently addressed in the 2004 ADAAG.

ALTERNATE DESIGN (SSAD)

Clarify petition for ADOPTION, AMENDMENT,

Tax Map Key:

(TAX MAP KEY)

or REPEAL of design specifications.

Applicant:

(DEPARTMENT/AGENCY)

b) Indicate applicable guidelines (2004 ADAAG,

(ADDRESS)

RHAG, etc.).

(CITY, STATE, ZIP)

Specify SECTION NUMBER and TITLE within the

Location:

(COUNTY-PROJECT ADDRESS)

guidelines. One section per application.

Request:

(BRIEF DESCRIPTION/REASON

d) Write a brief description and justification for your

FOR SSAD)

request. A written justification shall be attached not

to exceed five (5) typewritten pages. Justification

Project information and plans are on file in the office of the

shall include requester's interest in the subject

Disability and Communication Access Board, 919 Ala Moana

matter, including the reasons for the request; and a

Boulevard, Room 101, Honolulu, Hawaii 96814 and are

discussion of the requester's reasons and positions

available to the public for inspection during office hours. Free

or contentions and legal authorities in support of the

copies of the project information and plans may be obtained

requester's position or contention.

by calling 274-3141, ext. 68121 (from Kauai), 984-2400, ext.

Provide SIGNATURE and DATE Application.

68121 (from Maui) or 974-4000, ext. 68121 (from Hawaii).

Complete SITE SPECIFIC ALTERNATE DESIGN

INFORMATION (SSAD).

Persons wishing to comment are requested to submit five

a) Project Title, Job Number, and Tax Map Key.

copies of their testimony prior to or at the hearing. Persons

b) Identify the Department/Agency that is responsible

requiring any special accommodation (i.e., large print

for the project and their mailing address.

materials, sign language interpreter) is asked to provide such

Contact person's name and title

request 72 hours prior to the scheduled hearing. This request

d) Telephone and facsimile number

may be made in writing to the Disability and Communication

e) Provide brief site specific description.

Access Board at the address above or by calling (808) 586-

Documents for SSAD

8121 (Voice/TTY), or the above numbers for outer islands.

a) All documents related to a SSAD shall be sent

Disability and Communication Access Board

by mail or hand-carried to the DCAB office in

________________________, Executive Director

Honolulu, Hawaii. The date on which the papers

are received by DCAB shall be the date of filing.

Application Form Disability And Communication Access Board - Hawaii Page 2

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