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Access Complaint Form

Title VI of the 1964 Civil Rights Act requires that “No person in the United States shall, on the basis of race, color, national origin, sex, age, disability, low income and limited English proficiency (LEP), be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity receiving federal financial assistance.” (42 U.S.C. §2000d et seq.)

The Illinois Department of Revenue (IDOR) is committed to providing meaningful access to all visitors, including individuals who are limited English proficient (LEP), by addressing access issues.

An access issue identifies barriers to access which may include things such as inaccessible websites, videos without captions, lack of interpreter or translation services, or barriers related to an event, service, program, or facility.

If you have an access issue, please complete this form and submit it within thirty (30) days of the date of the incident.

If you have questions, please email REV.EEO@illinois.gov.

A printable PDF version of this form (IDR-962) is available.

All personal information in your complaint will be kept confidential.

Tell us about your access issue(s)

Step 1. Information about you

Please complete the information below.

Please note: You must include your contact information if you wish to be informed of the steps we are taking in response to your access issue.

Step 2

Step 3

Step 4

Please provide details related to your complaint that describe the problem(s) or concern(s).

Please provide details related to your complaint that describe the problem(s) or concern(s). Details may include, but are not limited to: incident location; date and time incident occurred; IDOR systems involved (i.e. software, webpages or documents on the website); employees or other people involved. Additional sheets may be attached if necessary

If there are additional witnesses to the incident(s) or concern(s) who were not identified in the  response above, please provide each witness’s name, phone number, and email address below.

Name/Phone/Email

Name/Phone/Email

Name/Phone/Email

Step 5