Reasonable Modification Accommodation Request Form

Please complete this form to request a reasonable modification/accommodation of OCTA’s bus transit services. Submit the completed form to OCTA’s Federal Compliance Officer or Reasonable Modification Coordinator via email at ADAInquiries@octa.net, or via mail at P.O. Box 14184, Orange, CA 92863-1584.

First Name *

Last Name *

Phone Number

Address

City

Zipcode

If you are an OC ACCESS customer, please indicate OC ACCESS ID#

Description of Your Reasonable Modification/Accommodation Request:

Specific location where we may need to take action: (if applicable):

Is this request related to a disability? *

Yes

Are you able to use OCTA's bus transit services without this modification? *

Yes

Please explain:

I have reviewed and agree to the Terms of Use and Privacy Policy of OCTA.net.

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Reasonable Modification Accommodation Request Form