49 CFR Appendix A to Subpart H of Part 37 - 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]