ADA & Reasonable Accommodation - Moline Housing Authority

ADA

The Moline Housing Authority is an equal opportunities housing provider and as such we comply with ADA.

Reasonable Accommodations Policies and Procedures

Your Right to Request a Reasonable Accommodation

Do I have the right to request a reasonable accommodation or modification of my unit while in pubic or assisted housing?

You have the right to request a reasonable accommodation or modification if you have a disability that requires you to need:

An accommodation or adjustment in the program’s rules, policies, practices or services, or
A modification of your Public Housing unit or its associated premises

Will my request automatically be approved?

We will try to approve your request if you can show that you have a disability that requires a reasonable accommodation or modification, and your request is reasonable.

How do I file a request?

You can request a reasonable accommodation by filling out a

Reasonable Accommodation Request Form available at

The Moline Housing Authority,
4141 11th Avenue A,
Moline, IL, 61265

or by calling 309-764-1819 during regular business hours.

A TTY number is available in the area for hearing impaired persons.

If you need help filing out this form, or if you want to give us your request in some other way, we will help you.

What happens after I file the request?

Your request will be reviewed and you will receive a response within 30 calendar days after we have received your request. If we turn down your request, we will explain the reasons. You will have a right to a hearing if your request is denied.

Request for a Reasonable Accommodation

Head of Household

Email

Address(Required)

Street Address Address Line 2 City State ZIP Code

Day Phone

Home Phone (if different)

1. The following member of my household has a disability

Name

Relationship

2. Please provide the following accommodation(s) so that the person listed above can comply with the requirements of the program and have an equal opportunity within the program to use and enjoy his/her unit and its associated premises.

Check the applicable request.

An accommodation or adjustment in the following program, rule, policy, practice or service that I currently must follow to meet the terms of the program. I understand that I may ask for change in howI meet the terms of the program’s rules and regulations. (Please be specific and explain what is needed. Attach a separate sheet if necessary for additional information.)

A modification in my unit or to another part of the associated housing complex. (Please tell what specifically is needed. Attach a separate sheet if necessary for additional information.) (NOTE: Applicable only to programs where the Moline Housing Authority owns the property.)

3. I need this reasonable accommodation because:

4. My request can be verified by the following Professional:

Name

Title

Organization

Address(Required)

Street Address City State ZIP Code

Phone

If there are other persons who can also verify your request, please fully identify them on a separate sheet and attach.

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