Title VI Information |

Title VI Notice to the Public

UCP of Hudson County, Inc. operates its program and services without regard to race, color, or national origin in accordance with Title VI of the Civil Rights Act of 1964, as amended. Any person who believes that he or she has been aggrieved by any unlawful discriminatory practice under Title VI may file a complaint in writing to UCP of Hudson County. To file a complaint, or for more information on UCP of Hudson County’s obligations under Title VI write to: UCP of Hudson County, 721 Broadway, Bayonne, NJ 07002 or visit www.ucpofhudsoncounty.org. Transportation services provided by this agency are in part funded through federal funds received through NJ Transit and as an individual you also have the right to file your complaint to both UCP of Hudson County as well as the Federal Transit Administration. Complaints may also be filed with the Federal Transit Administration in writing and may be addressed to: Title VI Program Coordinator, East Building, 5th Floor-TCR,
US Department of Transportation, Federal Transit Administration, Office of Civil Rights, 1200 New Jersey Ave., SE, Washington DC 20590

If information is needed in another language, contact 201-436-2200.

Título VI aviso al público
UCP of Hudson County opera sus programas y servicios sin importar raza, color o origen nacional según el título VI de la ley de derechos civiles de 1964 enmendada. Cualquier persona que cree que él o ella ha sido agraviado por cualquier práctica discriminatoria ilegal bajo el título VI puede presentar una queja por escrito al oficial de cumplimiento corporativo de UCP of Hudson Country. Para presentar una queja o para obtener más información sobre las obligaciones de capacidades bajo el Titulo VI escribir: UCP of Hudson County, 721 Broadway, Bayonne, NJ 07002 o visita www.ucpofhudsoncounty.org. Servicios de transporte prestados por esta agencia son total o parcialmente financiado mediante fondos federales recibidos a través de NJ TRANSIT y como individuo también tiene el derecho a presentar su queja con la Administración Federal de tránsito escribiendo a: Coordinadora del programa Título VI, edificio este, 5 º piso – TCR, los E.E.U.U. Departamento del transporte, FTA, Office of Civil Rights, 1200 New Jersey Avenue, SE, Washington, DC 20590.
Si necesita información en otro idioma, comuníquese con: 201-436-2200.

Note: This information is posted in all FTA funded vehicles used to operate UCP of Hudson County’s Transportation Program and on UCP of Hudson County’s website. It is also provided in large print format.

A. Complainant’s Information:

Name *

Address *

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone *

Email *

Accessible Format Requirements? (Select one or more)

• Large Print
• TDD
• Audio Tape
• Other

__________________________________________________________________

B. Person discriminated against (if someone other than complainant):

Name

First

Last

Address

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone

Email

Relationship to the person for whom you are complaining:

Please explain why you have filed for a third party:

Please confirm that you have obtained the permission of the aggravated party if you are filing on behalf of a third party.YesNo

__________________________________________________________________

State of Layout

C. Which of the following best describes the reason you believe the discrimination took place?

RaceColorNational OriginOther

Which?

__________________________________________________________________

D. On what date(s) did the alleged discrimination take place?

Date 1 *

Date 2

Date 3

__________________________________________________________________

E. Please describe the alleged discrimination. Explain what happened and whom you believe was responsible. Describe all persons who were involved. Include the name and contact information of the person(s) who discriminated against you (if known) as well as names and contact information of any witnesses.

__________________________________________________________________

F. Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court? List all that apply.

F. Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court? List all that apply.

• Federal Agency
• Federal Court
• State Agency
• State Court
• Local Agency

If you have checked above, please provide information about a contact person at the agency/court where the complaint was filed.

Name

First

Last

Address

Address Line 1

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Phone

Email

__________________________________________________________________

G. Please sign below. You may attach any written material or other information that you think is relevant to your complaint.

Signature *

Date / Time *

Date

Time

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