This version of the form is not currently in use and is provided for reference only. Download this version of the document for the current year.
This is a legal document that was released by the New York State Department of Health - a government authority operating within New York.
The document is provided in Chinese.
Q: What is the Language Access Complaint Form?
A: The Language Access Complaint Form is a form provided by the state of New York to file a complaint regarding language access services.
Q: Who can file a complaint using this form?
A: Any individual who feels that they have been denied access to language services can file a complaint using this form.
Q: What language is this form available in?
A: This form is available in Chinese language for residents of New York.
Q: What information do I need to provide on the form?
A: The form will ask for details such as your contact information, the name of the agency involved, and a description of the incident or denial of language services.
Form Details:
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