Witness One Information:
Witness Two Information:
AFFIRMATION
I hereby swear/affirm that the information provided in this Complaint Form is true and correct to the best of my knowledge, information and belief.
Date Complaint Received:______________
Date Investigation Completed:____________
Accepted for Investigation on:_______________
Departments complaint referred to:________________________________________
Rejected for investigation on: ______________
Reason: ____________________________________________________________________________
___________________________________________________________________________________
Title VI Compliance Complaint
ATA CUSTOMER SERVICE DEPARTMENT
Area Transportation Authority of North Central Pennsylvania
44 Transportation Center
Johnsonburg, PA 15845-2102
Office of Civil Rights
FEDERAL TRANSIT ADMINISTRATION
1200 New Jersey Avenue, SE
Washington, DC 20290
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