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40th JUDICIAL DISTRICT
AMERICANS WITH DISABILITIES ACT (TITLE II) POLICY
he Unified Judicial System of Pennsylvania (UJS) complies with Title II of the
Americans with Disabilities Act (ADA) which provides that “no qualified individual
with a disability shall, by reason of such disability, be excluded from participation
in or be denied the benefits of the services, programs, or activities of a public
entity, or be subjected to discrimination by any such entity”. 42 U.S.C.A. §12132.
Pursuant to that requirement, if you are an individual with a disability who needs
an accommodation in order to participate in any judicial proceeding or any other
service, program, or activity of the UJS, you are entitled, at no cost to you, to the
provision of certain assistance. The ADA does not require the 40th Judicial
District (The Indiana County Court of Common Pleas/ Magisterial District Court)
to take any action that would fundamentally alter the nature of its programs or
services, or impose an undue financial or administrative burden.
If you require an accommodation under the ADA, it is recommended that you
make your request as soon as possible or at least three (3) business days before
your scheduled participation in any court proceeding or UJS program or activity.
All requests for accommodation, regardless of timeliness, will be given due
consideration and if necessary, may require an interactive process between the
requestor and the 40th Judicial District (Indiana County Court of Common
Pleas/Magisterial District Court) to determine the best course of action.
To request a reasonable accommodation, please complete the Request for
Reasonable Accommodation Form (Appendix A) and return it to:
DA Coordinator /Assistant Court Administrator
Indiana County Courthouse
825 Philadelphia St. 3rd Floor
Indiana, PA 15701
Telephone: 724-465-3955
FAX: 724-463-2532
f you need assistance completing this form, contact the ADA Coordinator/
Assistant Court Administrator.
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Complaints alleging violations of Title II under the ADA may be filed pursuant to
the UJS Grievance Procedure with:
DA Coordinator/ Assistant Court Administrator
Indiana County Courthouse
825 Philadelphia St. 3rd Floor
Indiana, PA 15701
724-465-3955
FAX 724-463-2532
response will be sent to you after careful review of the facts.
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APPENDIX A
40TH
JUDICIAL DISTRICT
UNIFIED JUDICIAL SYSTEM OF PENNSYLVANIA
AMERICANS WITH DISABILITES ACT ACCOMMODATION (ADA) TITLE II REQUEST FOR REASONABLE ACCOMMODATION FORM
(INCLUDES REQUEST FOR INTERPRETER FOR HEARING /SPEECH IMPAIRED)
Litigant
Plaintiff
Parent
Child
Witness
Attorney
Victim
Juror
Client Information – Section A
Name:
Address:
Please check the box that most closely describes your status in this matter:
Other (please explain)
Defendant
Requestor Information (if different from above)
Name:
Address:
Relationship
to Client:
Phone:
Email:
Mobile:
Bus. Phone/
Mobile:
Fax:
Email:
TTY:
Accommodation
Nature of the disability for which an accommodation is requested:
Accommodation requested:
Location of Proceeding
Magisterial District Court No.
District Judge Name:
Criminal Division
Civil Division
Orphans’ Court Division
Family Division
Adult
Juvenile
Specify Address:
Proceeding Information (if known)
Case #:
Case Name:
Judge:
Proceeding
Date:
Proceeding
Type:
AFTER COMPLETING THE FORM, PLEASE SEND TO: ADA COORDINATOR /ASSISTANT COURT ADMINISTRATOR
INDIANA COUNTY COURTHOUSE
825 PHILADELPHIA ST. FLOOR 3
INDIANA, PA 15701
Proceeding
Time:
Fax:
Email:
Date to
Provider:
End Date
& Time:
Signature:
Date:
hereby certify that an Americans with Disabilities Act accommodation is required in the above-captioned action on the date stated.
Signature:
Date:
Court Official Verification – Section C
VERIFYING OFFICIAL SHALL MAINTAIN A COPY IN THE COURT’S CASE FILE AND PROVIDE THE ORIGINAL TO THE SERVICE PROVIDER FOR SUBMISSION WITH BILLING.
hereby verify that the services were performed by the provider in the above-captioned action on the date and time stated.
FOR OFFICIAL USE ONLY
Service Provider Information - Section B
A SERVICE REQUEST HAS BEEN MADE FOR THE CLIENT NAMED ABOVE.
Service Provider
Company:
Individual
Interpreter Name:
Bus. Phone/
Mobile:
Start Date
& Time:
Court Official:
Title:
(Please print name)
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40th Judicial District
Americans with Disabilities (Title II) Act Grievance Procedure
his grievance procedure is established for the prompt resolution of complaints
alleging any violation of Title II of the Americans with Disabilities Act (ADA) in the
provision of services, programs, or activities by the Unified Judicial System
(UJS). If you require a reasonable accommodation to complete this form, or
need this form in an alternate format, please contact:
DA Coordinator /Assistant Court Administrator
Indiana County Courthouse
825 Philadelphia St. 3rd Floor
Indiana, PA 15701
724-465-3955
FAX 724-463-2532
o file a complaint under the Grievance Procedure please take the following
1. Complete the complaint form and return to the ADA
Coordinator/Assistant Court Administrator as listed above. Alternative
means of filing complaints will be made available for persons with
disabilities upon request. The complaint should be submitted as soon
as possible but no later than sixty (60) calendar days after the alleged
violation.
2. Within fifteen (15) calendar days of receipt of the complaint, the ADA
Coordinator/Assistant Court Administrator will investigate the complaint,
including, meeting with the individual seeking an accommodation, either
in person or via telephone, to discuss the complaint and the possible
resolutions. Within fifteen (15) calendar days of the meeting, the ADA
Coordinator/Assistant Court Administrator will respond in writing, and
where appropriate, in a format accessible to the complainant, such as
large print, Braille, or audio. The response will explain the position of
the 40th Judicial District (Indiana County Court of Common
Pleas/Magisterial District Court) and offer options for substantive
resolution of the complaint.
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steps:
3. If the response to the complaint does not satisfactorily resolve the
issue, the complainant may appeal the decision within fifteen (15)
calendar days after receipt of the response to the President Judge or
his or her designee. Within fifteen (15) calendar days after receipt of
the appeal, the President Judge or his or her designee will meet with
the complainant to discuss the complaint and possible resolutions.
Within fifteen (15) calendar days after the meeting, the President Judge
or his or her designee will respond in writing, and, where appropriate, in
a format accessible to the complainant, with a final resolution of the
complaint.
This grievance procedure is informal. An individual’s participation in this informal
process is completely voluntary. Use of this grievance procedure is not a
prerequisite to and does not preclude a complainant from pursuing other
remedies available under law.
he UJS Policy on Non-Discrimination and Equal Employment Opportunity also
encompasses disability-related issues and provides complaint procedures for
UJS court users. Any employment-related disability discrimination complaints
will be governed by the UJS Policy on Nondiscrimination and Equal Employment
Opportunity.
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40TH
JUDICIAL DISTRICT
UNIFIED JUDICIAL SYSTEM OF PENNSYLVANIA
AMERICANS WITH DISABILITES ACT (ADA) TITLE II
GRIEVANCE FORM
Grievant Information
Alternative Contact Person (other than Grievant)
Home Phone
(include area code):
Business Phone
(include area code):
Mobile Phone
(include area code):
Home Phone
(include area code):
Business Phone
(include area code):
Relationship
To Client:
Court Service, Program or Facility Allegedly in Violation
Date and Location of Alleged Violation (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?
If You Answered “Yes” to the Previous Question, Complete the Following
Contact Person:
Phone
(include area code):
Date Filed:
Grievant Name:
Address:
Name:
Address:
Yes No
Agency or Court:
Address:
Other Comments
Signature: ________________________________________________ Date: __________________________________________
