Federal Transit Administration (FTA) Expedited Project Delivery Pilot Program (EPD)
FTA

Online Civil Rights Complaint Form

Fields marked with asterisk '*' are mandatory

Please tell us why you are filing this complaint.


I believe that I have been (or someone else has been) discriminated against on the basis of: (Select all that apply) *


Other (Specify the type of discrimination you believe occurred.) *


I believe that a transit agency has failed to comply with the following program requirements: (Select all that apply) *


Other (Specify) *


Specify the type of complaint you are filing. (Select all that apply)


Other (Specify) *


Clearly explain what happened and why you believe you were discriminated against. Include specific details such as names, dates, times, route numbers, locations and any other relevant information that would assist us in understanding and investigating your allegations. *


Attach any documentation that is relevant to this complaint, including any related correspondence from your transit agency.


Maximum file size is 100 MB. Please use PDF or compressed files in order to limit file size. The following are the allowed file formats: pdf, doc, docx, xls, xlsx, ppt, pptx, bmp, gif, png, jpg, jpeg, swf, html, txt, odt, rtf, mp4, mp3, wmv, flv, zip.



Paratransit Eligibility Complaint

FTA does not investigate individual paratransit eligibility determinations or provide or accept appeals of local determinations. DOT ADA regulations specify who is to be determined ADA paratransit eligible. Transit agencies, with input from the communities they serve, develop their specifics of their own eligibility processes. Disability alone does not determine paratransit eligibility. Paratransit eligibility is based on an applicant’s functional ability to use fixed route service and is not a medical decision.

FTA may investigate allegations of noncompliance with ADA regulations regarding the transit agency’s overall eligibility determination process. This may include deficiencies related to written notification of eligibility decisions, an opportunity for an appeal, and provision of transportation if there is no decision within 30 days of completing the local appeal.

If your complaint involves a paratransit eligibility, you will be asked to submit a copy of the transit agency’s initial decision letter and a copy of the appeal decision upholding the denial (or grant of conditional or temporary eligibility) to FTA. An investigator needs these details, and any relevant communications from your transit agency, to substantiate process deficiencies that may have impacted your eligibility decision.


Your local transit agency: (Select all that apply) *


Did you appeal your local transit agency’s decision? *

Yes

No


Describe the conditions that you feel are preventing your use of fixed route service and why you believe the transit agency made the wrong eligibility decision in your case. *


Tell us the date you filed your appeal to your local transit agency. *


Clearly explain what happened and why you believe you were discriminated against. *


Attach a copy of your local transit agency’s initial decision letter. *


Maximum file size is 100 MB. Please use PDF or compressed files in order to limit file size. The following are the allowed file formats: pdf, doc, docx, xls, xlsx, ppt, pptx, bmp, gif, png, jpg, jpeg, swf, html, txt, odt, rtf, mp4, mp3, wmv, flv, zip.



Attach a copy of your local transit agency’s appeal decision letter. *


Maximum file size is 100 MB. Please use PDF or compressed files in order to limit file size. The following are the allowed file formats: pdf, doc, docx, xls, xlsx, ppt, pptx, bmp, gif, png, jpg, jpeg, swf, html, txt, odt, rtf, mp4, mp3, wmv, flv, zip.



Attach a copy of any relevant communications from your local transit agency to substantiate that you pursued the local transit agency’s appeal process.


Maximum file size is 100 MB. Please use PDF or compressed files in order to limit file size. The following are the allowed file formats: pdf, doc, docx, xls, xlsx, ppt, pptx, bmp, gif, png, jpg, jpeg, swf, html, txt, odt, rtf, mp4, mp3, wmv, flv, zip.



Paratransit On-Time Performance Complaint

DOT ADA regulations prohibit transit agencies from limiting ADA complementary paratransit service to eligible individuals by means of a “pattern or practice” — or a substantial number — of untimely pickups, trip denials, lengthy trips, and other operational practices. A “pattern or practice” involves regular, or repeated actions, not isolated, accidental, or singular incidents. A missed trip, late arrival, or trip denial now and then does not constitute a violation of ADA regulations. Also, operational problems that the transit agency could not have anticipated when the trip was scheduled do not count as part of a pattern or practice.

For this reason, FTA recommends that riders experiencing service issues keep a detailed log of their trips for at least 30 days, or longer if they ride the service infrequently. Include details about your trip issues such as dates, times, paratransit pickup windows, whether your trips were booked by pickup or appointment time, etc. An investigator needs these details to investigate your complaint.


Clearly explain what happened and why you believe you were discriminated against. *


Include specific details such as dates, times and any other relevant information that would assist us in our investigation of your allegations. *


Include specific details such as trip lengths, pickup and drop-off locations, and an explanation of what occurred on this date and time, and any other relevant information.


Attach any documentation that is relevant to this complaint, including any related correspondence from your local transit agency.


Maximum file size is 100 MB. Please use PDF or compressed files in order to limit file size. The following are the allowed file formats: pdf, doc, docx, xls, xlsx, ppt, pptx, bmp, gif, png, jpg, jpeg, swf, html, txt, odt, rtf, mp4, mp3, wmv, flv, zip.


Please provide your contact information in the event that we need to reach you during our investigation.


Full Name: *


Street Address: *


City: *


State: *


Zip Code: *


Home Phone Number:


Cell/Mobile Phone Number:


Email Address: *


Check below if you have accessible format requirements: (Select all that apply)


Other (Specify your accessible format requirements.) *

Please tell us if you are filing this complaint for yourself or for someone else.


Are you filing this complaint on your own behalf? *

Yes

No


Supply the name of the person for whom you are filing this complaint and your relationship to them. *


Have you obtained the permission of the aggrieved person to file this complaint on their behalf? *

Yes

No


Explanation for not having permission. *

Please provide the following information for your local transit agency.


The name of the local transit agency this complaint is against. *


FTA encourages riders to first file complaints with their local transit agencies to give them an opportunity to resolve the issue. The ADA and Title VI require transit agencies to have a process for promptly investigating and responding to customer complaints.
Have you filed this current complaint with your local transit agency or another agency? (Select all that apply) *


Other (Specify the “other” agency with which you filed a complaint.) *

Local Transit Agency Filing


Tell us the date you filed this complaint with your local transit agency.


Tell us how you filed the complaint and to whom the complaint was directed at the transit agency.


Describe the response you received to your complaint from the local transit agency. Include the date of the response and attach a copy of any written response you received to your complaint.

Date of Response


Description of Response


Attach copy of Response, if provided.


Maximum file size is 100 MB. Please use PDF or compressed files in order to limit file size. The following are the allowed file formats: pdf, doc, docx, xls, xlsx, ppt, pptx, bmp, gif, png, jpg, jpeg, swf, html, txt, odt, rtf, mp4, mp3, wmv, flv, zip.


Legal Proceedings


Have you filed a lawsuit regarding this complaint? *

Yes

No


Date you filed the lawsuit.


Court and case number.


Attach a copy of any case-related materials.


Maximum file size is 100 MB. Please use PDF or compressed files in order to limit file size. The following are the allowed file formats: pdf, doc, docx, xls, xlsx, ppt, pptx, bmp, gif, png, jpg, jpeg, swf, html, txt, odt, rtf, mp4, mp3, wmv, flv, zip.


We need your consent to disclose your name, if necessary, in the course of any investigation. We need your permission and signature to move forward with your complaint.


FTA may be unable to investigate your allegations without permission to release your identity and complaint. May we release your identity and a copy of your complaint to the transit agency? *

Yes

No


I, , hereby certify on 03/27/2023 that the information provided in this form is complete, true and correct to the best of my knowledge. *