Americans with Disabilities Act – Accommodation Request Form

City of Pittsburgh
Americans with Disabilities Act – Accommodation Request Form
ADA Coordinator’s Office, Department of City Planning

This Request for Accommodation form was established to meet the requirements of the Americans with Disabilities Act of 1990 (ADA), as amended. The Americans with Disabilities Act is a federal civil rights law that provides people with disabilities equal access to employment, state and local government programs, goods and services. The City of Pittsburgh is committed to making programs, services, and facilities accessible to all people. Under Title II of the ADA, the City of Pittsburgh is required to ensure that our facilities, services and programs are accessible to people with disabilities and in compliance with the ADA. The City will not place a surcharge on a particular individual with a disability or any group of individuals with disabilities to cover the cost of providing auxiliary aids/services or reasonable modifications of policy.

City of Pittsburgh ADA Coordinator
200 Ross St, 4th Floor
Pittsburgh, PA 15219


Alternative means of filing complaints, such as personal interviews or a tape recording of the complaint will be made available for persons with disabilities upon request.

*Attention, those planning to submit an accommodations request or grievance form by US mail:

COVID-19 Change of Procedure: To submit an accommodations request or grievance form, please email TBD. Mail is not being received in the office at this time. If you are unable to use this method, please contact the ADA Coordinator to request an accommodation.

Accommodation Policy

If the ADA Coordinator is able to grant the accommodation, the petitioner will be notified within 5 business days of receipt of the request and no further action will be required by the petitioner. The request will then be implemented by the appropriate City Department.

If the ADA Coordinator is unable to grant the accommodation request, the petitioner will be notified of the decision, along with his/her rights to file a grievance under the City’s Grievance Procedure, in a format acceptable to the petitioner.

ADA Accommodation Request Form

Instructions: Please fill out the form completely. Once you have done so, please hit “submit.” If a required field does not apply, please enter “N/A.” If you do not know the information under required filed, please enter “unknown.”

Click here to view form.