Americans with Disabilities Act (ADA) Complaint Template

PRELIMINARY — SELECT COMPLAINT TYPE

☐ My complaint arises under Title I (employment)
☐ My complaint arises under Title II (public entity)
☐ My complaint arises under Title III (public accommodation)
☐ My complaint arises under more than one Title: [________________________________]

PART A — COMPLAINANT INFORMATION

Full Name: [________________________________]
Address: [________________________________]
City: [________________________________] State: [____] ZIP: [____]
Phone: [(___) ___-____]
Email: [________________________________]

Legal Representative (if any):
Attorney: [________________________________] | Firm: [________________________________]
Phone: [(___) ___-____] | Email: [________________________________] | Bar No.: [____]

PART B — RESPONDENT INFORMATION

Name of Respondent: [________________________________]
Organization / Business Name: [________________________________]
Address: [________________________________]
City: [________________________________] State: [____] ZIP: [____]
Phone: [(___) ___-____]

Type of Respondent:
☐ Private employer (Title I)
☐ State government agency / department (Title II)
☐ County / city / municipal entity (Title II)
☐ Public transit authority (Title II)
☐ Restaurant / hotel / retail store (Title III)
☐ Theater / entertainment venue (Title III)
☐ Medical office / hospital (Title III)
☐ Private school / university (Title III — but see Title II for public universities)
☐ Website / digital service (Title II — April 2024 DOJ web rule; Title III — courts apply)
☐ Other: [________________________________]

PART C — DISABILITY DESCRIPTION

Describe your disability or impairment:
[________________________________]
[________________________________]

Major life activities substantially limited by the disability (check all that apply):
☐ Caring for oneself ☐ Performing manual tasks ☐ Seeing ☐ Hearing
☐ Eating ☐ Sleeping ☐ Walking ☐ Standing ☐ Lifting ☐ Bending
☐ Speaking ☐ Breathing ☐ Learning ☐ Reading ☐ Concentrating
☐ Thinking ☐ Communicating ☐ Working ☐ Interacting with others
☐ Major bodily function: [________________________________] (immune system, digestive, bladder, bowel, neurological, brain, respiratory, circulatory, endocrine, reproductive)
☐ Other: [________________________________]

ADAAA Broadened Definition (Pub. L. 110-325, effective January 1, 2009): Congress enacted the ADAAA in response to Toyota Motor Mfg., Kentucky, Inc. v. Williams, 534 U.S. 184 (2002) and Sutton v. United Air Lines, Inc., 527 U.S. 471 (1999), which had narrowly construed "disability." The ADAAA directs that the definition shall be "broadly construed" and not require "extensive analysis." Mitigating measures (except ordinary eyeglasses) SHALL NOT be considered when assessing whether a limitation is substantial. Episodic impairments (e.g., epilepsy, cancer in remission) are disabilities if they would substantially limit a major life activity when active.

Basis of ADA Coverage:
☐ Actual disability — I have a physical or mental impairment that substantially limits a major life activity described above
☐ Record of disability — I have a history or record of such impairment
☐ Regarded as disabled — Respondent took adverse action because it perceived me as having an impairment (no need to show substantial limitation; "regarded as" standard covers impairments that are not transitory and minor)

PART D — TITLE I EMPLOYMENT DISCRIMINATION (Complete if Title I claim)

D-1. Employment Information

Position / Job Title: [________________________________]
Date of Hire: [__/__/____] Date of Termination (if applicable): [__/__/____]
Salary / Hourly Rate: $[____]

Type of Adverse Employment Action:
☐ Failure to hire
☐ Termination / discharge
☐ Demotion
☐ Reduction in pay or hours
☐ Failure to promote
☐ Failure to provide reasonable accommodation
☐ Hostile work environment based on disability
☐ Retaliation for requesting accommodation or filing complaint
☐ Other: [________________________________]

D-2. Reasonable Accommodation

Date accommodation was requested: [__/__/____]
Accommodation(s) requested: [________________________________]

Interactive Process: Under the ADA, once an employee requests an accommodation, the employer is required to engage in an "interactive process" — a good-faith dialogue to identify a reasonable accommodation. See 29 C.F.R. § 1630.2(o)(3). The employer's failure to engage in the interactive process may itself support an ADA violation.

Employer's response to accommodation request:
☐ Granted as requested
☐ Denied — stated reason: [________________________________]
☐ No response provided
☐ Counter-offer / alternative accommodation: [________________________________]
☐ Interactive process was: ☐ Conducted in good faith ☐ Not initiated ☐ Terminated prematurely

Did employer claim undue hardship? ☐ Yes ☐ No
If yes, explain employer's stated basis: [________________________________]

Undue Hardship Standard: An employer need not provide an accommodation if it would impose an "undue hardship" — i.e., an action requiring significant difficulty or expense, considering: (1) the nature and cost of the accommodation; (2) the overall financial resources of the facility; (3) the type of operation; and (4) the impact on operations. 42 U.S.C. § 12111(10).

Direct Threat Defense (if raised by employer):
☐ Employer claimed direct threat to health/safety. This defense requires showing a significant risk of substantial harm that cannot be eliminated or reduced by reasonable accommodation, based on an individualized assessment of objective evidence. Chevron U.S.A. Inc. v. Echazabal, 536 U.S. 73 (2002).

D-3. Title I Damages Cap Reference

(Back pay and front pay are NOT subject to the cap. No punitive damages against state/local government employers.)

EEOC Charge required before Title I suit: File within 180 days (300 days in deferral states) of the discriminatory act with the EEOC. 42 U.S.C. § 12117(a).

PART E — TITLE II PUBLIC ENTITY CLAIM (Complete if Title II claim)

E-1. Public Entity / Program Information

Public entity name: [________________________________]
Program, service, or activity at issue: [________________________________]
Date(s) of discrimination: [__/__/____]

Type of Title II Violation (check all that apply):
☐ Denied access to programs, services, or activities because of disability
☐ Denied equal opportunity to participate in or benefit from programs/services
☐ Provided services that were not equally effective as those provided to persons without disabilities
☐ Failure to provide reasonable modifications to policies, practices, or procedures (28 C.F.R. § 35.130(b)(7))
☐ Failure to provide effective communication (auxiliary aids and services — 28 C.F.R. § 35.160)
☐ Physical access barriers at government facility
☐ Website or digital accessibility — failure to comply with WCAG 2.1 Level AA standards

DOJ Web Accessibility Rule (April 24, 2024): The DOJ issued a final rule under Title II requiring state/local governments to make websites and mobile apps meet WCAG 2.1 Level AA. Compliance deadlines: April 24, 2026 for entities serving populations of 50,000 or more; April 24, 2027 for smaller entities. Note: In October 2025, DOJ announced it would re-examine these regulations; monitor for updates.

☐ Retaliation for exercising Title II rights (28 C.F.R. § 35.134)
☐ Other: [________________________________]

Describe the specific conduct and violation:
[________________________________]
[________________________________]

Remedies Available Under Title II:
- Injunctive relief
- Compensatory damages (requires showing of intentional discrimination — deliberate indifference standard, not just negligence)
- Attorney fees and costs
- Section 504 (Rehabilitation Act) provides parallel remedy for federally funded entities; may allow compensatory damages on lower showing

Where to file a Title II complaint:
☐ DOJ ADA Complaint: ada.gov (180 days from last discriminatory act)
☐ Private lawsuit: U.S. District Court (2-year statute of limitations; no exhaustion required)
☐ Relevant federal funding agency complaint (if discrimination involves federally funded program — also triggers Section 504)

PART F — TITLE III PUBLIC ACCOMMODATION CLAIM (Complete if Title III claim)

F-1. Public Accommodation Information

Business / Facility Name: [________________________________]
Address: [________________________________]
Type of Public Accommodation (12 categories under 42 U.S.C. § 12181(7)):
☐ Inn / hotel / motel / lodging
☐ Restaurant / bar / food establishment
☐ Movie theater / entertainment venue / stadium
☐ Auditorium / convention center / lecture hall
☐ Bakery / grocery / clothing / retail establishment
☐ Laundromat / dry cleaner / bank / barber / travel service / gas station
☐ Accounting / law / healthcare / hospital / insurance office
☐ Terminal / depot / train station / airport
☐ Museum / library / gallery / park / zoo / amusement park / place of recreation
☐ Nursery / elementary / secondary / undergraduate / postgraduate school (private)
☐ Day care center / senior center / homeless shelter / food bank / adoption agency
☐ Gymnasium / spa / bowling alley / golf course
☐ Other place of exhibition or recreation: [________________________________]
☐ Website / digital service (courts applying Title III; DOJ has stated WCAG 2.1 AA is the standard)

Date(s) of visit / attempted access / digital access: [__/__/____]

Barriers encountered:

Architectural / Physical Barriers (2010 ADA Standards for Accessible Design):
☐ Inaccessible parking (slope, width, signage, access aisle — Standards §§ 502, 208)
☐ Inaccessible route from parking to entrance (Standards § 206)
☐ Inaccessible entrance (door hardware, width, threshold — Standards §§ 404, 206.4)
☐ Inaccessible route within facility (Standards § 402)
☐ Inaccessible restroom (turning space, grab bars, fixture heights — Standards §§ 603-606)
☐ Inaccessible sales/service counter (Standards § 904)
☐ Inaccessible seating (wheelchair spaces, companion seats, lines of sight — Standards §§ 221, 802)
☐ Inaccessible signage (raised characters, Braille — Standards §§ 703, 216)
☐ Inadequate accessible route slope exceeding 1:20 (Standards § 402.2)
☐ Other: [________________________________]

Communication / Policy Barriers:
☐ Failure to provide auxiliary aids or services (sign language interpreter, captioning, large print, audio description — 42 U.S.C. § 12182(b)(2)(A)(iii))
☐ Discriminatory policy or practice not modified for disability (42 U.S.C. § 12182(b)(2)(A)(ii))
☐ No-pets policy applied to service animal in violation of 28 C.F.R. § 36.302(c)
☐ Website inaccessible to screen reader or assistive technology
☐ Other: [________________________________]

Readily Achievable Barrier Removal (42 U.S.C. § 12182(b)(2)(A)(iv)):

Under Title III, removal of existing architectural barriers is required when "readily achievable" — i.e., easily accomplishable and able to be carried out without much difficulty or expense. Factors: (1) nature/cost of removal; (2) financial resources of facility; (3) type of operation. For new construction (after January 26, 1993) and alterations, the standard is "readily accessible to and usable by individuals with disabilities" — a higher standard than readily achievable.

☐ Barrier removal is readily achievable because: [________________________________]
☐ Alternative methods of providing access exist: [________________________________]

Title III Remedies:

Under federal Title III, the ONLY monetary relief available is injunctive relief and attorney fees. No compensatory or punitive damages under federal Title III. 42 U.S.C. § 12188(a)(2). However, state analogs (e.g., California Unruh Act) provide damages.

PART G — STATE LAW ANALOG CLAIMS

California:
☐ Unruh Civil Rights Act (Cal. Civ. Code § 51): Entitles persons to full and equal accommodations, advantages, facilities, privileges, or services in all business establishments. Violation of ADA is a per se violation of Unruh. Statutory damages: $4,000 per violation ($8,000 if defendant failed to respond to pre-suit demand within 30 days under Cal. Civ. Code § 55.56). Actual damages also available. Attorney fees mandatory.
☐ California Disabled Persons Act (Cal. Civ. Code § 54 et seq.): Prohibits denial of equal access to public accommodations for persons with disabilities. Statutory damages: $1,000 minimum per violation.
☐ FEHA (Cal. Gov. Code § 12940): Employment discrimination by employers with 5+ employees.

New York:
☐ New York Human Rights Law (N.Y. Exec. Law § 296): Prohibits disability discrimination in employment, housing, and places of public accommodation. Compensatory damages available; no punitive damages. Attorney fees at court's discretion.
☐ New York City Human Rights Law: Broader protections; permits punitive damages; "any person aggrieved" standing.

Florida:
☐ Florida Civil Rights Act (Fla. Stat. § 760.01 et seq.): Prohibits disability discrimination in employment, housing, and places of public accommodation. Compensatory and punitive damages available.

Texas:
☐ Texas Accessibility Standards (Tex. Gov. Code § 469): Enforced by Texas Department of Licensing and Regulation (TDLR); applies to state-funded construction.
☐ Texas Human Resources Code § 121.001 et seq.: Rights of persons with disabilities in public facilities.

PART H — DESCRIPTION OF EVENTS AND HARM

Date(s) of incident(s): [__/__/____] through [__/__/____]

Narrative — What happened? What barriers or violations did you encounter? What accommodations or modifications were requested and denied? What injury or harm did you suffer?

[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

Evidence Available:
☐ Photographs of barriers
☐ Video documentation
☐ Written denial of accommodation
☐ Correspondence with respondent
☐ Medical / disability documentation
☐ Expert accessibility consultant report
☐ Witness statements
☐ Other: [________________________________]

Intent to Return / Ongoing Deterrence:
☐ Plaintiff intends to return to the facility but is deterred by the continued existence of barriers.
Describe: [________________________________]

PART I — FILING OPTIONS AND STATUTE OF LIMITATIONS CHART

PART J — PRAYER FOR RELIEF (COURT COMPLAINT)

Plaintiff(s) seek the following relief:

☐ Preliminary and permanent injunction ordering Respondent to remove the barriers identified in Exhibit [____] and to implement the following specific measures: [________________________________]
☐ Declaratory judgment that Respondent's conduct and/or facilities violate the ADA
☐ Compensatory damages for: emotional distress, out-of-pocket expenses, and other actual damages (Title I and II; state analogs)
☐ Statutory damages under California Unruh Act / state analog — $[____] per violation
☐ Punitive damages (state analog claims)
☐ Reasonable attorney fees, litigation expenses, and costs (42 U.S.C. § 12205; Cal. Civ. Code § 55; Fla. Stat. § 760.11)
☐ Other: [________________________________]

COURT COMPLAINT CAPTION AND SIGNATURE BLOCK

UNITED STATES DISTRICT COURT
FOR THE [________________________________] DISTRICT OF [________________________________]

[________________________________], an individual with a disability,
Plaintiff,

v. Case No. [To Be Assigned]

[________________________________],
Defendant.

COMPLAINT FOR INJUNCTIVE RELIEF AND DAMAGES
(ADA Titles [____]; [State Law Analog Claims])

JURY TRIAL DEMANDED (as to state law claims)

Respectfully submitted,

[________________________________]
[Attorney Name], Bar No. [____]
[________________________________]
[Law Firm Name / Address / Phone / Email]
Date: [__/__/____]

ATTORNEY NOTES

☐ For California Unruh Act serial litigation cases, review Cal. Civ. Proc. Code § 425.50 (high-frequency litigant pleading requirements, verified complaint, prelitigation site inspection).
☐ For federal Title III cases: send demand letter before filing, describing violations and requesting remediation — courts may consider refusal to remediate in attorney fee awards.
☐ Evaluate whether new construction/alteration vs. existing facilities — different legal standards apply.
☐ Website accessibility claims: monitor DOJ re-examination of Title II web rule announced October 2025 and any changes to Title III digital access enforcement.
☐ Section 504 may offer compensatory damages where Title III does not — identify all federal funding connections.
☐ Consider expert witness (Certified Access Specialist — CASp in California; accessibility consultant in other states) to document and quantify violations.