ADA TITLE III COMPLAINT

Public Accommodation Discrimination

PART I: COMPLAINT INFORMATION

Complaint Filing Date: _______________________

Method of Filing:
☐ U.S. Department of Justice Online Portal
☐ U.S. Department of Justice by Mail
☐ Private Civil Action (Federal Court)

PART II: COMPLAINANT INFORMATION

Full Legal Name: _______________________

Street Address: _______________________

City: _______________________ State: _______ ZIP Code: ___________

Telephone Number: _______________________

Email Address: _______________________

Preferred Method of Contact:
☐ Telephone
☐ Email
☐ U.S. Mail

Do you require accommodations for communication?
☐ No
☐ Yes - Please specify: _______________________

Are you filing on behalf of yourself or another person?
☐ Self
☐ On behalf of another individual
☐ On behalf of an organization

If filing on behalf of another, provide their information:

Name of Individual/Organization: _______________________

Relationship to Complainant: _______________________

Contact Information: _______________________

PART III: RESPONDENT (BUSINESS/FACILITY) INFORMATION

Name of Business/Public Accommodation: _______________________

Type of Public Accommodation (select all that apply):

☐ Place of lodging (hotel, motel, inn)
☐ Restaurant or establishment serving food/drink
☐ Place of exhibition or entertainment (theater, stadium)
☐ Place of public gathering (auditorium, convention center)
☐ Sales or rental establishment (retail store, shopping center)
☐ Service establishment (bank, insurance office, professional office)
☐ Public transportation terminal/station
☐ Place of public display or collection (museum, library, gallery)
☐ Place of recreation (park, zoo, amusement park)
☐ Place of education (private school, day care)
☐ Social service center establishment (homeless shelter, food bank)
☐ Place of exercise or recreation (gym, golf course)

Business Street Address: _______________________

City: _______________________ State: _______ ZIP Code: ___________

Business Telephone Number: _______________________

Business Website (if applicable): _______________________

Name of Owner/Manager (if known): _______________________

PART IV: DESCRIPTION OF DISABILITY

Nature of Disability (describe in general terms):

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Does your disability substantially limit one or more major life activities?
☐ Yes
☐ No

Major Life Activities Affected (select all that apply):

☐ Walking
☐ Seeing
☐ Hearing
☐ Speaking
☐ Breathing
☐ Learning
☐ Reading
☐ Concentrating
☐ Thinking
☐ Communicating
☐ Manual tasks
☐ Caring for oneself
☐ Working
☐ Standing
☐ Lifting
☐ Bending
☐ Other: _______________________

Do you use assistive devices or require auxiliary aids?
☐ No
☐ Yes - Please specify:

☐ Wheelchair
☐ Walker/Cane
☐ Service Animal
☐ Hearing Aid
☐ Sign Language Interpreter
☐ Screen Reader
☐ Other: _______________________

PART V: DESCRIPTION OF DISCRIMINATION

Date(s) of Incident(s): _______________________

Time of Incident(s): _______________________

Type of Discrimination Alleged (select all that apply):

☐ Denial of full and equal enjoyment of goods/services
☐ Failure to make reasonable modifications to policies/practices
☐ Failure to provide auxiliary aids and services
☐ Failure to remove architectural barriers
☐ Denial of entry or access
☐ Segregation or unequal treatment
☐ Use of eligibility criteria that screen out disabled individuals
☐ Failure to maintain accessible features
☐ Inaccessible website or digital services
☐ Retaliation for asserting ADA rights
☐ Other: _______________________

Detailed Description of Incident(s):

Provide a chronological, detailed account of what happened. Include specific facts such as: what you were trying to do, who you spoke with, what was said, what barriers you encountered, and how you were treated differently.

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Witnesses (if any):

PART VI: BARRIERS ENCOUNTERED

Architectural/Physical Barriers (if applicable):

☐ No accessible entrance
☐ No accessible parking spaces
☐ Parking spaces not properly marked/signed
☐ Ramps missing or non-compliant
☐ Doorways too narrow
☐ Heavy doors without automatic openers
☐ No accessible restrooms
☐ Counters/service desks too high
☐ Inaccessible aisles/pathways
☐ No elevator access
☐ Stairs without handrails
☐ Lack of accessible seating
☐ No accessible dressing rooms
☐ Other: _______________________

Communication Barriers (if applicable):

☐ No sign language interpreter provided
☐ No assistive listening devices
☐ No Braille materials
☐ No large print materials
☐ No closed captioning
☐ Staff refused to communicate in writing
☐ Inaccessible website (not screen reader compatible)
☐ Inaccessible mobile application
☐ Videos without captions
☐ PDF documents not accessible
☐ Other: _______________________

Policy/Practice Barriers (if applicable):

☐ Service animal denied entry
☐ Companion/aide denied entry
☐ Refused to modify policies for disability
☐ Required unnecessary medical documentation
☐ Required disclosure of disability nature
☐ Applied discriminatory eligibility criteria
☐ Charged extra fees due to disability
☐ Other: _______________________

PART VII: PRIOR COMPLAINTS OR ACTIONS

Have you previously complained to the business about this issue?
☐ No
☐ Yes

If yes, provide details:

Date of Prior Complaint: _______________________

Method (verbal, written, email): _______________________

Person Contacted: _______________________

Response Received: _______________________

_____________________________________________________________________________

Have you filed a complaint with any other agency regarding this matter?
☐ No
☐ Yes

If yes, provide details:

Agency Name: _______________________

Date Filed: _______________________

Case/Reference Number: _______________________

Have you filed a lawsuit regarding this matter?
☐ No
☐ Yes

If yes:

Court: _______________________

Case Number: _______________________

Status: _______________________

PART VIII: REQUESTED RELIEF

What actions would you like the business to take? (select all that apply):

☐ Remove architectural barriers
☐ Provide auxiliary aids and services
☐ Modify discriminatory policies or practices
☐ Train staff on ADA requirements
☐ Install accessible features (specify): _______________________
☐ Provide accessible website/digital services
☐ Post notice of nondiscrimination
☐ Other: _______________________

PART IX: SUPPORTING DOCUMENTATION

Documents Attached (check all that apply):

☐ Photographs of barriers
☐ Video recordings
☐ Written correspondence with business
☐ Receipts/proof of visit
☐ Medical documentation (if voluntarily provided)
☐ Witness statements
☐ Website accessibility audit results
☐ Other: _______________________

PART X: CERTIFICATION AND SIGNATURE

I certify under penalty of perjury that the information provided in this complaint is true and correct to the best of my knowledge, information, and belief.

I understand that:
- Filing a false complaint may subject me to legal penalties
- The Department of Justice may share this complaint with the respondent
- Investigation timelines vary and there is no guarantee of specific outcomes
- I may pursue private legal action at any time

Signature: _______________________ Date: _______________________

Printed Name: _______________________

STATE-SPECIFIC NOTES

CALIFORNIA

• California Unruh Civil Rights Act (Cal. Civ. Code Section 51): Provides broader protections than federal ADA. Statutory minimum damages of $4,000 per violation are available in private lawsuits.
• California Disabled Persons Act (Cal. Civ. Code Section 54): Additional state protections for access to public accommodations.
• Construction-Related Accessibility Standards Compliance Act (CRASCA): Requires pre-litigation notice for construction-related accessibility claims with 60-day response period.
• Certified Access Specialist (CASp) Inspection: Businesses with CASp inspections may receive certain litigation protections.
• Statute of Limitations: Two years for Unruh Act claims.

TEXAS

• Texas Human Resources Code Chapter 121: State disability rights law providing additional protections.
• Texas Accessibility Standards (TAS): State architectural standards that may impose requirements beyond federal ADA standards.
• No State Monetary Damages: Texas law does not provide for monetary damages in private accessibility suits; federal ADA remedies apply.
• Attorney General Enforcement: Texas Attorney General may pursue enforcement actions.
• Statute of Limitations: Follows federal standards; state personal injury statute of two years may apply.

FLORIDA

• Florida Civil Rights Act (Fla. Stat. Section 760.01 et seq.): State anti-discrimination protections.
• Florida Building Code Accessibility Requirements: State accessibility standards.
• High Volume Filing Jurisdiction: Florida is among the top states for ADA Title III lawsuits.
• Pre-Suit Notice: No state-mandated pre-suit notice requirement, but recommended.
• Statute of Limitations: Four years for most civil actions.

NEW YORK

• New York Human Rights Law (N.Y. Exec. Law Section 296): Provides broader protections and allows compensatory damages not available under federal ADA.
• New York City Human Rights Law: Even broader protections within NYC.
• High Volume Filing Jurisdiction: New York leads the nation in ADA Title III federal filings.
• State Damages: Unlike federal ADA, New York law permits compensatory and punitive damages in private suits.
• Statute of Limitations: Three years for Human Rights Law claims.

FILING INSTRUCTIONS

Department of Justice Filing

Online: https://civilrights.justice.gov/

By Mail:
U.S. Department of Justice
Civil Rights Division
Disability Rights Section
950 Pennsylvania Avenue, NW
Washington, DC 20530

Telephone (for questions): (800) 514-0301 (Voice) / (800) 514-0383 (TTY)

Important Information

1. No Filing Deadline with DOJ: There is no strict statute of limitations for filing with the Department of Justice, but complaints should be filed as soon as possible while evidence is fresh.

2. Private Lawsuit Deadlines: If pursuing a private civil action, state statutes of limitations apply (typically 2-4 years depending on jurisdiction).

3. Mediation: DOJ may refer complaints to its ADA Mediation Program for voluntary resolution.

4. Confidentiality: Complainant information is kept confidential to the extent permitted by law.

5. No Attorney Required: You do not need an attorney to file a DOJ complaint, but legal counsel is recommended for private lawsuits.

APPENDIX: PUBLIC ACCOMMODATION CATEGORIES (42 U.S.C. Section 12181(7))

Title III covers the following twelve categories of private entities:

1. Places of lodging
2. Establishments serving food or drink
3. Places of exhibition or entertainment
4. Places of public gathering
5. Sales or rental establishments
6. Service establishments
7. Public transportation terminals
8. Places of public display or collection
9. Places of recreation
10. Places of education
11. Social service center establishments
12. Places of exercise or recreation

Note: Religious organizations and private membership clubs are generally exempt from Title III requirements.

This template is based on current ADA Title III requirements as of January 2026. Federal civil penalties for ADA violations can reach $75,000 for first violations and $150,000 for subsequent violations. Consult current regulations and legal counsel for the most up-to-date requirements.