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49 C.F.R. Appendix A to Subpart H of Part 37—Service Request Form

Title 49 - Transportation

Title 49: Transportation
PART 37—TRANSPORTATION SERVICES FOR INDIVIDUALS WITH DISABILITIES (ADA)
Subpart H—Over-the-Road Buses (OTRBs)

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Appendix A to Subpart H of Part 37—Service Request Form

Form for Advance Notice Requests and Provision of Equivalent Service

1. Operator's name____________________
2. Address____________________
____________________
3. Phone number:____________________
4. Passenger's name:____________________
5. Address:____________________
____________________
6. Phone number:____________________
7. Scheduled date(s) and time(s) of trip(s):____________________
____________________
8. Date and time of request:____________________
9. Location(s) of need for accessible bus or equivalent service, as applicable: ____________________

10. Was accessible bus or equivalent service, as applicable, provided for trip(s)? Yes ____  no ____

11. Was there a basis recognized by U.S. Department of transportation regulations for not providing an accessible bus or equivalent service, as applicable, for the trip(s)? Yes ____  no ____

If yes, explain ____________________
____________________

[66 FR 9054, Feb. 6, 2001]

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