Suffolk County, NY · Suffolk County
Access to Services in Your Language: Complaint Form
Suffolk County residents can use this form to report problems accessing county services or programs because of language barriers.
At a glance
- Issued by
- City of Suffolk County · Suffolk County, Suffolk County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- suffolkcountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This form lets people report language-access problems with Suffolk County services and programs, including interpreter, translation, or service delays. It asks for the complainant’s contact and preferred-language information, details about what happened and when and where it occurred, and any previous complaint to the department or agency. The county asks complainants to print and sign the form in black ink and return it by mail, fax, or email.
Who needs it
A person who experienced a language-access problem with a Suffolk County service or program can complete and submit this complaint form.
How to submit it
Print and sign the form in black ink, then mail it to the Suffolk County Office of Community Services, H. Lee Dennison Building, 100 Veteran’s Memorial Hwy., Hauppauge, NY 11788. The form also lists fax 631-853-8271 and [email protected].
About notarization
This complaint form is signed and dated without a notary; no notarized or sworn attachment is identified.
How to submit this form
- 1
Download the Form
Download the Suffolk County language-access complaint form.
- 2
Complete the Form
Provide your contact details, preferred language, and information about the problem, including when and where it happened.
- 3
Add Details if Needed
Use additional pages if needed, and write your name on each page.
- 4
Sign and Submit
Sign in black ink and return the form by mail, fax, or email using the contact information printed on it.
Frequently asked questions
- Do I need a notary for the Access to Services in Your Language: Complaint Form?
- No. The form asks the complainant to sign and date it, but does not require a notary. No notarized or sworn attachment is identified.
- How do I submit the language-access complaint form?
- Print and sign it in black ink. The form says to return it by mail to the Suffolk County Office of Community Services, by fax, or by email using the contact details printed on the form.
- What information does the complaint form ask for?
- It asks for contact and preferred-language information, details about the language-access problem and when and where it happened, and information about any earlier complaint to the department or agency.