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ACAA Final Rule.pdf - United Airlines

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APPENDIX A TO PART 382 – REPORT OF DISABILITY-RELATED COMPLAINT DATA<br />

Name of Carrier: __________________________ Submission Date: __________________________<br />

Contact Person: Period of Data Collection: _____________________<br />

Name: _________________________________________________________________________________________<br />

Telephone # (include country code if outside the U.S.): __________________________________________________<br />

Email address: _________________________________________________________________________________<br />

Mailing address: __________________________________________________________________________________<br />

Total number of complaints (i.e., incidents): __________________________<br />

REPORT OF DISABILITY-RELATED COMPLAINT DATA<br />

Vision<br />

Impaired<br />

Hearing<br />

Impaire<br />

d<br />

Vision<br />

&<br />

Hearing<br />

Impaire<br />

d<br />

Paraplegi<br />

c<br />

Quadriplegi<br />

c<br />

Other<br />

wheelchai<br />

r<br />

Oxyge<br />

n<br />

Stretche<br />

r<br />

Other<br />

Disabilit<br />

y<br />

Other<br />

Assistive<br />

Device<br />

Mentall<br />

y<br />

Impaire<br />

d<br />

Communicabl<br />

e Disease<br />

Allergie<br />

s<br />

Refusal<br />

To Board<br />

Passenger<br />

Refusal to<br />

Board w/o<br />

Attendant<br />

Security<br />

Issues<br />

Regarding<br />

Disability<br />

Aircraft<br />

Not<br />

Accessible<br />

Airport<br />

Not<br />

Accessible<br />

Advance<br />

Notice<br />

Dispute<br />

Seating<br />

Accomm-

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