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 Haitian Creole.
Q: What is the Language Access Complaint Form?
A: The Language Access Complaint Form is a form used to file a complaint regarding language access services.
Q: Who can use the Language Access Complaint Form?
A: Anyone who has experienced a language access issue in New York and speaks Haitian Creole can use the form.
Q: What is the purpose of the Language Access Complaint Form?
A: The purpose of the form is to report and address any language access problems or barriers faced by individuals who speak Haitian Creole.
Q: What information is required on the Language Access Complaint Form?
A: The form asks for details about the language access issue, personal information of the complainant, and any supporting documents or evidence.
Q: Is there a deadline for submitting the Language Access Complaint Form?
A: The form should be submitted as soon as possible after the language access issue occurs, but there is no specific deadline mentioned.
Q: What will happen after I submit the Language Access Complaint Form?
A: The agency responsible for language access services will review the complaint and take appropriate action to address the issue.
Q: Are there any fees associated with filing a Language Access Complaint Form?
A: No, there are no fees associated with filing a complaint using the Language Access Complaint Form.
Form Details:
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