Fillable Civil Rights Complaint Form printable pdf download

Civil Rights Complaint Form

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Civil Rights Complaint Form

The Federal Transit Administration Office of Civil Rights is responsible for ensuring that

providers of public transit properly implement several civil rights laws and programs, including

Title VI of the Civil Rights Act of 1964, the Americans with Disabilities Act of 1990 (ADA), the

Disadvantaged Business Enterprise (DBE) program, and the External Equal Employment

Opportunity (EEO) program.

In the FTA complaint investigation process, we analyze the complainant's allegations for possible

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.

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

If you have questions about how to prepare a complaint, you may contact our toll-free FTA

Assistance Line at 1-888-446-4511. More information about transit-related civil rights

requirements may be found on the FTA’s website at

Note: Apart from the form, on separate pages, please describe your complaint. You

should include specific details such as names, dates, times, route numbers, witnesses,

and any other information that would assist us in our investigation of your allegations.

Please also provide any other documentation that is relevant to this complaint, including

any related correspondence from your transit provider.

We cannot accept your complaint without a signature, so please sign on the

Important:

last page of the form after printing out.

Section I

I believe that I have been (or someone else has been) discriminated against on the basis

of:

Race / Color / National Origin

Disability

Not Applicable

Other (specify)

Civil Rights Complaint Form

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