Nassau County, NY

Language Access Complaint Form

New York State’s language access policy requires certain public-facing agencies to offer interpretation services in any language and to translate important documents into at least the top twelve most common non-English languages in the state. If you have had trouble with our agency’s language access services, you may complete and submit this complaint form using the contact information provided above. All personal information in your complaint will be kept confidential.

Complainant Information

I prefer not to provide my name

Please note, if you do not provide any contact information, we will not be able to inform you of the steps we are taking to respond to your complaint.

First Name: *

Last Name: *

Zip Code:*

Preferred language(s): *

Phone Number: *

Email Address: *

Is someone else helping you file this complaint? *

First Name: *

Last Name: *

Phone Number: *

Email Address: *

What language(s) did you need services in? *

What was the problem? *

Check all the boxes that apply and explain below.

I was not offered an interpreter

I asked for an interpreter and was denied

The interpreter's skills were not good (include their names in the"Describe what happened" field below, if known)

The interpreter made rude or inappropriate comments

I waited for too long for an interpreter

I was not given forms or notices in a language I can understand (list documents needed in the "Describe what happened" field below)

Other

Please Explain: *

When did this incident happen?

If it happened more than once, indicate the date of the most recent incident.

Date: *

Time: *

Where did this incident happen? *

Provide Address: *

Describe what happened: *

Be specific and provide as much detail as possible. If it happened more than once, include each date/time and describe each incident. List any services and documents you were trying to access. Include names, addresses, and phone numbers of people involved, if known.

Did you complain to anyone from the Department/Agency? *

Include who you spoke with and what their response was: *

Please be specific.

All fields marked with a red asterisk (*) are required