New York > Statewide > Department Of Motor Vehicles
Driver Program Regulation Complaint Form DPR-201 - New York
| Driver Program Regulation Complaint Form Form. This is a New York form and can be used in Department Of Motor Vehicles Statewide . |
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New York State Department of Motor Vehicles DTP-201 (8/12) DRIVER TRAINING PROGRAMS COMPLAINT FORM www.dmv.ny.gov Use this form to register a complaint based on your experience with a driver training program, a driver training instructor, or both. OFFICE USE ONLY BUSINESS ID NUMBER CLIENT ID NUMBER COMPLAINT ABOUT A DRIVER TRAINING PROGRAM, INSTRUCTOR, OR BOTH Mark the box or boxes below that apply to your complaint. PROGRAM INSTRUCTOR o o o o o Driver Education Program Driving School Point and Insurance Reduction Program Delivery Agency Point and Insurance Reduction Program Sponsor Internet or Electronic Point and Insurance Reduction Program o Driver Education Instructor o Driving School Instructor o Point and Insurance Reduction Program Instructor o Pre-licensing Instructor COMPLAINT ABOUT A PROGRAM Complete this section if your complaint is about a driver training program. Program Name Program Address City State Zip Code COMPLAINT ABOUT AN INSTRUCTOR Complete this section if your complaint is about a driver training instructor. Instructor's Last Name Instructor's First Name Name of the Program, School, Delivery Agency or Program Sponsor Instructor's Address City State Zip Code PAGE 1 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com COMPLAINANT You must complete this section. DMV does not accept anonymous complaints. Your Last Name Your First Name DTP-201 (8/12) Your M.I. Suffix Your Address City State Zip Code Your Email Address Your Home Phone Your Work Phone ( ) ( ) DESCRIPTION OF COMPLAINT Write the date or dates of this incident here:_____________________________________________________________ Write a full description of your complaint. If necessary, attach more pages. If there is a hearing to resolve this complaint, will you agree to testify? o Yes Attach the COPIES of letters or other documents that support your complaint. o No If there is a hearing, I understand that the hearing will use a copy of this complaint and the other documents from me. I understand that DMV also can provide these copies to the program or instructor named in this complaint. I understand that this complaint and information about this complaint can be provided for a Freedom of Information (FOIL) request. I understand that DMV will not provide any personal information about me, except my name, unless required to legally. Your Signatureç Mail or fax this ORIGINAL complaint form, with copies of the documents that support your complaint, to: New York State Department of Motor Vehicles Driver Training Programs 6 Empire State Plaza Albany NY 12228 Fax: (518) 473-0160 Date OFFICE USE ONLY Complaint Number reset/clear PAGE 2 OF 2 American LegalNet, Inc. www.FormsWorkFlow.com
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