Form Ftb 5722 C1 PDF Details

In a world where equal access and accommodations for individuals with disabilities are paramount, the Franchise Tax Board (FTB) provides a structured avenue for addressing concerns related to the Americans with Disabilities Act (ADA) Title II through the FTB 5722 C1 form. This form is specifically designed to ensure that any disparities or shortcomings in providing adequate accommodation for disabilities within the FTB's services, programs, or facilities can be formally recognized and addressed. It asks for detailed information about the grievant, including their name, address, phone numbers, and the nature of the ADA violation they are alleging. Additionally, it inquires if the case has previously been filed with the Department of Justice or any other government agencies or courts, further signifying the seriousness with which these allegations are taken. Complete with instructions to print, sign, and mail the document to the FTB's Equal Employment Opportunity Office, the form is an essential tool for safeguarding rights under the ADA and advocating for necessary changes or accommodations. Through the FTB 5722 C1 form, the FTB encourages transparency, responsiveness, and a commitment to the principles of equality and accessibility for all.

QuestionAnswer
Form NameForm Ftb 5722 C1
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesyyyy, Grievant, ftb 5722, FTB

Form Preview Example

Americans With Disabilities Act (ADA) Title II

GRIEVANCE FORM

Purpose: Use this form to file a grievance if you find that the Franchise Tax Board has not provided adequate accommodation for a disability.

Instructions: Complete this form, print it, sign it and mail to:

FRANCHISE TAX BOARD

EQUAL EMPLOYMENT OPPORTUNITY OFFICE MS A163

PO BOX 550

SACRAMENTO CA 95812-0550

Grievant Information

Grievant Name

Address

 

 

City

 

 

State

ZIP Code

 

 

 

 

Home Phone (include area code)

Business Phone (include area code)

 

(

)

(

)

 

 

 

Person (other than Grievant) Alleging an ADA Violation

 

 

 

 

 

 

 

 

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

City

 

 

State

ZIP Code

 

 

 

 

Home Phone (include area code)

Business Phone (include area code)

 

(

)

(

)

 

FTB Service, Program or Facility Allegedly in Violation

Date Alleged Violation Occurred (dd/mm/yyyy)

Description Of Alleged Violation and Requested Remedy

Has this case been filed with the Department of Justice or other government agency or court?

Yes

 

No

FTB 5722 C1 (NEW 06-2005) SIDE 1

If You Answered “Yes” to the Previous Question, Complete the Following

Agency or Court

Contact Person

Address

City

State

ZIP Code

 

 

 

 

Phone (include area code)

Date Filed (dd/mm/yyyy)

 

 

( ) –

Other Comments

Signature ______________________________________________________________ Date: ___________________

FTB 5722 C1 (NEW 06-2005) SIDE 2

How to Edit Form Ftb 5722 C1 Online for Free

Any time you would like to fill out FTB, you don't need to install any kind of software - just make use of our PDF editor. Our team is always endeavoring to expand the tool and enable it to be much better for users with its cutting-edge functions. Enjoy an ever-evolving experience today! Here's what you'd need to do to start:

Step 1: Click on the "Get Form" button at the top of this webpage to open our PDF tool.

Step 2: This tool lets you modify most PDF files in a variety of ways. Modify it by writing customized text, correct what's already in the PDF, and put in a signature - all possible in minutes!

With regards to the blank fields of this particular form, this is what you want to do:

1. Begin completing your FTB with a group of major blank fields. Consider all of the necessary information and make certain there's nothing missed!

Grievant conclusion process clarified (part 1)

2. Now that the previous segment is complete, it is time to put in the necessary specifics in Has this case been filed with the, Yes, and FTB C NEW SIDE so that you can proceed to the third stage.

Tips on how to fill out Grievant stage 2

Those who work with this form often get some points incorrect when filling out Yes in this part. Be certain to double-check whatever you type in here.

3. In this specific step, examine Agency or Court, Contact Person, Address, City, State, ZIP Code, Phone include area code, Date Filed ddmmyyyy, and Other Comments. All these should be filled out with highest attention to detail.

ZIP Code, Other Comments, and Date Filed ddmmyyyy in Grievant

4. To go forward, this step involves filling in several empty form fields. Examples of these are Signature Date, which are integral to carrying on with this particular document.

Filling out segment 4 of Grievant

Step 3: Always make sure that the details are correct and click on "Done" to finish the process. Acquire your FTB after you register here for a free trial. Easily get access to the pdf document from your FormsPal cabinet, along with any edits and adjustments conveniently synced! FormsPal is dedicated to the privacy of all our users; we make sure that all information used in our editor stays protected.