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Discrimination Complaint Form for Sumter County Transit Division

  1. The Federal Transit Administration (FTA) requires Transit Agencies to operate Transit Programs per Title VI without regard to Race, Color, National Origin, Age, or Family or Religious Status. The Americans with Disabilities Act (ADA) of 1990, As Amended must also be followed. Please complete this form if you feel you have been discriminated against for any reason.
  2. Section 1
  3. Accessible Format Requirements?
  4. Section 2
  5. If you answered "Yes" to this question, go to Section 3.
  6. Section 3
  7. I believe the discrimination I experienced was based on Title VI per FTA Circular 4702.1B (check all that apply below):*
  8. I believe the discrimination I experienced was based on Americans with Disabilities Act (ADA) per FTA Circular 4710.1:*
  9. Section 4
  10. Section 5
  11. If yes, check all that apply:
  12. Section 6
  13. By checking the box below and submitting this form, I affirm that I have read the above charge and that it is true to the best of my knowledge, information and belief.*
  14. If information is needed in another language, please contact (352) 689‐4400.
  15. Leave This Blank:

  16. This field is not part of the form submission.