Fillable Accessibility Contact Form (Export-Import Bank of the United States)

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Accessibility Contact Form (Export-Import Bank of the United States)

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The Accessibility Contact Form (Export-Import Bank of the United States) form is 2 pages long and contains:

  • 2 signatures
  • 2 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Export-Import Bank of the United States

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Information and Communication Technology (ICT)
Accessibility Contact Form
1. Contact Information
Name:
Date:
Email:
Phone:
TTY:
2. Request or Reason for Contact
Please answer Sections 3 and 4 if you are requesting accessible copies of on-line documents
or are requesting assistance in using an inaccessible EXIM product.
EXIM.gov
EXIM On-Line
data.exim.gov
research.exim.gov
EXIMConnect
Other (Describe):
3. Web site/System Name Web site/
4. Product informationWeb site/
Multimedia or video
Electronic document (PDF,MS Word etc.)
Web page
Electronic Form
Other (Describe):
Please give form, document or video name or other identifying information. Please include URL if possible.
5. Action Taken (For internal use only)
Date of Action Taken:
September 2019 ICT Accessibility Request Page 1 of 2
SUBMIT
6. Additional Follow up (for internal use)
Date of Follow up:
Accessibility Board Chair:
Approve Closure:
Chief Information Officer:
Approve Closure:
Signature:______________________________
Signature: ______________________________
Date:____________
Date: ____________
Accessibility Board Chair:
Date:
For questions or assistance filling out this form, contact the Accessibility Board: Accessibility_Board@EXIM.gov
March 2019 Page 2 of 2
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Accessibility Contact Form (Export-Import Bank of the United States)

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Completed 26 January 2021

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