ODOT Form FTA-ADA "Americans With Disabilities Act - Fta Complaint Form" - Oklahoma

What Is ODOT Form FTA-ADA?

This is a legal form that was released by the Oklahoma Department of Transportation - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 16, 2020;
  • The latest edition provided by the Oklahoma Department of Transportation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of ODOT Form FTA-ADA by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Transportation.

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Download ODOT Form FTA-ADA "Americans With Disabilities Act - Fta Complaint Form" - Oklahoma

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AMERICANS WITH DISABILITIES ACT - FTA COMPLAINT FORM
The Oklahoma Department of Transportation (ODOT) ensures that no person or groups of persons shall, on the grounds
of race, color, sex, religion, national origin, age, disability, retaliation or genetic information, be excluded from participation
in, be denied the benefits of, or be otherwise subjected to discrimination under any and all programs, services, or activities
administered by ODOT, its recipients, sub-recipients, and contractors. To request an accommodation please contact the
ADA Coordinator at 405-521-4140 or the Oklahoma Relay Service at 1-800-722-0353. If you have any ADA or Title VI
questions email ODOT-ada-titlevi@odot.org.
Date of Filing:
Name:
Address:
City, State, Zip Code:
Work Phone:
Home Phone:
Email Address:
Date of Alleged Incident:
Public Transit Provider Information:
Check the category box that your complaint relates to:
Discrimination
Other
Please provide a detailed description of the alleged incident. If there are any witnesses, please
provide their contact information. Attach additional pages as necessary.
Page 1 of 3
ODOT Form FTA-ADA
Revised 04/16/2020
AMERICANS WITH DISABILITIES ACT - FTA COMPLAINT FORM
The Oklahoma Department of Transportation (ODOT) ensures that no person or groups of persons shall, on the grounds
of race, color, sex, religion, national origin, age, disability, retaliation or genetic information, be excluded from participation
in, be denied the benefits of, or be otherwise subjected to discrimination under any and all programs, services, or activities
administered by ODOT, its recipients, sub-recipients, and contractors. To request an accommodation please contact the
ADA Coordinator at 405-521-4140 or the Oklahoma Relay Service at 1-800-722-0353. If you have any ADA or Title VI
questions email ODOT-ada-titlevi@odot.org.
Date of Filing:
Name:
Address:
City, State, Zip Code:
Work Phone:
Home Phone:
Email Address:
Date of Alleged Incident:
Public Transit Provider Information:
Check the category box that your complaint relates to:
Discrimination
Other
Please provide a detailed description of the alleged incident. If there are any witnesses, please
provide their contact information. Attach additional pages as necessary.
Page 1 of 3
ODOT Form FTA-ADA
Revised 04/16/2020
Please provide a suggested detailed plan or remedy for this complaint. Attach additional pages as
necessary.
Have you filed or do you intend to file a complaint concerning this incident with any other agencies
(Federal, State or Local)?
Yes
No
If so, please provide the following information:
Agency Name:
Address:
Name of Investigator:
Phone Number:
Email Address:
Date Filed:
Status of Complaint:
Page 2 of 3
ODOT Form FTA-ADA
Revised 04/16/2020
Please attach and/or provide any additional information that might be useful in processing
your complaint.
The completed form must be signed and submitted to the Oklahoma Department of
Transportation’s Civil Rights Division. If you require any assistance in filling out this form,
please contact the ADA Coordinator at 405-521-4140.
Signature
Date
Page 3 of 3
ODOT Form FTA-ADA
Revised 04/16/2020
Page of 3