Title II of the Americans with Disabilities Act

Section 504 of the Rehabilitation Act of 1973

Accessibility Complaint Form

This Complaint Procedure is established to meet the requirements of the Americans with Disabilities Act of 1990 (ADA). It may be used by anyone who wishes to file a complaint alleging discrimination on the basis of disability in the provision of services, activities, programs, or benefits by the Iowa Department of Transportation (Iowa DOT) or a local public agency in Iowa when it is related to vehicular or pedestrian transportation. The Iowa DOT's Personnel Policy governs employment-related complaints of disability discrimination.

Please provide the following information necessary in order to process your complaint. A formal complaint must be filed within 180 days of the occurrence of the alleged discriminatory act. Assistance is available upon request. Please contact the Civil Rights Bureau (CRB) at (515) 689-1009.

Complainant

Mail completed form to:

Iowa Department of Transportation

Civil Rights Bureau (CRB)

Amy Weerheim

ADA Coordinator

800 Lincoln Way

Ames, IA 50011

Or

FAX to:

(515) 239-1120

E-mail to:

Amy.Weerheim@iowadot.us or civil.rights@iowadot.us

For Official Use Only

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131103. Accessibility Complaint Form

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