Your contact information, if provided, is kept confidential:

Your name:




Daytime phone:



Precise description of each barrier:



Building or facility:


Address (or location):


Phone number:


The following information, if known, will help our investigation:

Owner of facility:




Phone number:



Federal   agencies occupying or managing the facility:


Federal   funds that may have been used to design, build, alter, or lease the facility:


Date(s)   building or facility was built or altered:


If possible, please include a sketch, drawing, map or photograph of the barrier(s).

Mail completed form to:

Access Board
Office of Compliance and Enforcement
1331 F Street, N.W., Suite 1000
Washington, DC 20004-1111