Form Ds-622 - Article 19-A Complaint Form
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1
2ARTICLE 19-A COMPLAINT FORM
dmv.ny.gov
Before filing your complaint, please attempt to settle this matter with the company or school.
Please note that we do not handle:
Employee/Employer disputes
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Discrimination claims
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Matters that are/have been litigated/arbitrated
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Issues challenging the validity of state or federal law
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Complaints against a current or former co-worker
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Complaints regarding a 19-A driver file audit (you must contact the appropriate Department of Motor Vehicles Testing &
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Investigation Unit)
To file a complaint against an Article 19-A Motor Carrier or Certified Examiner, complete the sections below. Please be as
INSTRUCTIONS:
specific as possible about the problem. Upon completion of the investigation, the Bus Driver Unit will send you written results of the
investigation.
NOTE: Anonymous complaints are allowed, but if you do not provide your contact information, the Bus Driver Unit cannot send you a reply
and may not be able to fully investigate if additional information is needed.
After you complete this form, send it with a copy of any supporting documentation to the Bus Driver Unit, using one of the following options:
Mail it:
New York State Department of Motor Vehicles
Bus Driver Unit
6 Empire State Plaza, Room 136B
Albany, NY 12228
Fax it:
(518) 474-0593
E-mail it:
busdriverunit@dmv.ny.gov
Submit it online at:
https://dmv.ny.gov/motor-carriers/information-and-forms-article-19
SECTION 1 (Answer each question)
Is this complaint about an Article 19-A Motor Carrier, Certified Examiner, or both (check one)
1.
o
o
o
MOTOR CARRIER
CERTIFIED EXAMINER
BOTH
o
o
2.
Are you willing to appear and testify at a hearing if one is held to resolve this complaint?
YES
NO
. . . . . . . . . . . . .
o
o
Do you want to remain anonymous in any investigation of the subject of this complaint?
3.
YES
NO
. . . . . . . . . . . . . .
NOTE: Anonymity will be provided at the investigation stage. Anonymity is not guaranteed in any hearing that may result from
the investigation, or in DMV’s response to a Freedom of Information Law (FOIL) request.
SECTION 2 - CONSUMER INFORMATION (*required field)
*
*
Last Name
First Name
Address
City
State
Zip Code
Email
Phone Number
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DS-622 (10/16)
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