Ada Complaint Form
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State of michigan ada complaint form. Department of justice civil rights division 950 pennsylvania avenue, nw washington, dc 20530 3. Sign and return to the address on page 3. To file a complaint using by mail, send your complaint form to the following address:
When You Use The Submit Button The Information Is Transmitted Electronically To The State Of Michigan Department Or Agency Selected, And At The Same Time The Information Is.
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Web address person denied disability access skip this section if you are filing this complaint for yourself. Name* (first, middle initial, and last) home phone* business phone email address state agency accused of denying disability access agency* department (if applicable) agency address phone number email incident details date of incident* Ada policy promotes use and acceptance of the most current version of the ada dental claim form by dentists and payers. Web the ada dental claim form provides a common format for reporting dental services to a patient's dental benefit plan.