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Federal forms, ICRs, and supporting documents

OMB control number

Americans with Disabilities Act Discrimination Complaint Form

OMB 1190-0009 · DOJ/CRT.

OMB 1190-0009

Under title II of the Americans with Disabilities Act, an individual who believes that he or she has been subjected to discrimination on the basis of disability by a public entity may, by himself or herself or by an authorized representative, file a complaint. This information collection form has been developed to simplify this process for complainants.

The latest form for Americans with Disabilities Act Discrimination Complaint Form expires 2021-09-30 and is listed under ICR 201806-1190-001.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 1190-0009 Americans with Disabilities Act Discrimination Complaint FormForm
30 day OMB 1190-0009 83 FR 28866 06 21 2018.pdf Supplementary Document
DRS title II supporting statement 1190-0009.docxSupporting Statement A
Certification Stmt 2015.doc Supplementary Document
Privacy Release_A.doc Supplementary Document
CFR Complaint.docx Supplementary Document
ADA Law 12131.docx Supplementary Document
Americans with Disabilities Act Discrimination Complaint Form Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
201806-1190-001 Extension without change of a currently approved collection 2018-06-21 Approved without change
201502-1190-001 Revision of a currently approved collection 2015-05-27 Approved with change
201201-1190-001 Extension without change of a currently approved collection 2012-01-26 Approved with change
201005-1190-003 Extension without change of a currently approved collection 2010-05-28 Approved without change
200701-1190-005 Extension without change of a currently approved collection 2007-04-18 Approved without change
200403-1190-001 Extension without change of a currently approved collection 2004-03-29 Approved with change
200010-1190-004 Extension without change of a currently approved collection 2000-10-31 Approved without change
199709-1190-001 New collection (Request for a new OMB Control Number) 1997-09-10 Approved without change