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ADA COMPLAINT FORM Please print out this form, fill it out and mail it to: Columbia County Transit, GDOT or the Federal Transit Administration. Name: Street Address: City or Town/State/Zip Code: Phone: Please provide the date(s) and location of the alleged discrimination, the name(s) of the individual(s) who allegedly discriminated against you including their titles (if known) or the lack of accessibility. Please provide the names, addresses and telephone numbers of any witnesses. Explain as briefly and as clearly as possible what happened, how you feel that you were discriminated against and who was involved. Please include how other persons were treated differently from you. Signature/Date You may use additional sheets of paper if necessary. Also include any written materials pertaining to your complaint. Address: Columbia County Transit : ADA Complaint PO Box 498 Evans, GA 30809 ---PAGE BREAK--- Columbia County Transit ADA Complaint Procedures If you have a complaint about the accessibility of our transit system or service, or believe you have been discriminated against because of your disability, you can file a complaint. Please provide all facts and circumstances surrounding your issue or complaint so we can fully investigate the incident. A) Complaint Filing a. Any person who feels they have been subjected to discrimination under the Americans with Disabilities Act (ADA) or has a complaint about the accessibility of Columbia County Transit system or services may file a complaint with the ADA Coordinator. b. A complaint must be filed within one hundred eight (180) days of the alleged incident. c. A complaint must be in writing on the Columbia County Transit ADA Complaint Form and signed by the complainant or his/her representative, and include the complainant’s name, address and telephone number. Complaints shall explain, as fully as possible, the facts and circumstances surrounding the alleged discriminatory action and individuals responsible for the alleged discriminatory action and names of any known witnesses. d. If you are unable to complete a written complaint due to a disability or if information is needed in another language, please contact us at [PHONE REDACTED] or 311 for assistance. B) Complaint Investigation a. Columbia County Transit will review the complaint to determine if it is appropriate under the ADA. b. If the complaint conforms to ADA standards and all the required information is provided, then the complaint will be accepted. c. Columbia County Transit may contact the complainant and witnesses if additional information is required. C) Complaint Disposition a. All complaint and investigation correspondence will be retained by Columbia County Transit. b. Columbia County Transit will respond in writing to the complainant with the findings of the investigation within 90 days of receipt of the complaint. c. If the complainant disagrees with the findings, he/she may request reconsideration by submitting a request in writing to the ADA Coordinator within ten (10) days of the date of Columbia County Transit’s letter. The request must include the basis for reconsideration. The ADA Coordinator will notify you of the decision to accept or reject the request for reconsideration within ten (10) days. If granted, the ADA Coordinator will issue a determination letter to the complainant upon completion of the reconsideration review. D) Additional Complaint Options Columbia County Transit encourages you to file the complaint with us. However, you may file a complaint with the Federal Transit Administration. Federal Transit Administration Office of Civil Rights 1200 New Jersey Avenue SE Washington, DC 20590