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