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 _______________________________
_______________________________
49 C.F.R. §A to Subpart H of Part 37