Form 2193 Download Fillable PDF or Fill Online Title VI and Ada
Ada Complaint Form. Please fill out this form completely, in black ink or type. Mail fill out and send the paper ada complaint form or a letter containing the same information, to:
Form 2193 Download Fillable PDF or Fill Online Title VI and Ada
Web title ii of the americans with disabilities act section 504 of the rehabilitation act of 1973 discrimination complaint form. Department of justice civil rights division 950 pennsylvania avenue, nw washington, dc 20530 3. Please remember to save and/or print your completed appeal form before using the submit button. Online file a complaint by submitting a report on the department of justice's civil rights division website. Web persons who want to file a complaint for reasons involving disability discrimination may do so, by completing this form and submitting it via u.s. State of michigan ada complaint form. Sign and return to the address on page 3. You will receive a confirmation number and your report is immediately sent to our staff for review. Web address person denied disability access skip this section if you are filing this complaint for yourself. Ada policy promotes use and acceptance of the most current version of the ada dental claim form by dentists and payers.
Mail fill out and send the paper ada complaint form or a letter containing the same information, to: Name* (first, middle initial, and last) home phone* business phone email address state agency accused of denying disability access agency* department (if applicable) agency address phone number email incident details date of incident* Ada policy promotes use and acceptance of the most current version of the ada dental claim form by dentists and payers. Use this chart to find the right agency and the process for filing your complaint. Online file a complaint by submitting a report on the department of justice's civil rights division website. City, state and zip code: State of michigan ada complaint form. Mail fill out and send the paper ada complaint form or a letter containing the same information, to: If you have experienced discrimination because of your disability, you can file a complaint with the government. Web address person denied disability access skip this section if you are filing this complaint for yourself. Please remember to save and/or print your completed appeal form before using the submit button.
