Do I need a notary for the Access to Services in Your Language Complaint Form?

No. The form asks you to sign and date your statement without a notary. If you use additional pages, print your name on each one.

How do I submit the language access complaint form?

Print and sign it with black ink, then send it by mail, fax, or email to the Suffolk County Office of Community Services using the contact details printed on the form.

What information does the complaint form ask for?

It asks for your contact details and preferred language, information about when and where the problem happened, and a specific description of what occurred.

Can someone help me file this complaint?

Yes. The form asks whether someone else is helping you file. If so, it requests that person's first and last name.

Suffolk County, NY · Suffolk County

No notary required

Access to Services in Your Language Complaint Form

Suffolk County residents 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: Oct 5, 2026
Machine-readable: JSON record · about the forms index

What this form is

This form lets someone report a language-access problem involving public services or programs, such as not being offered an interpreter or not receiving forms in a language they understand. It asks for the complainant’s contact and preferred-language details, when and where the problem occurred, and a description of what happened. The county says the information is confidential.

Who needs it

A person who experienced a language barrier while trying to use public services, programs, or activities can complete this complaint form.

How to submit it

Print and sign the form in black ink, then send it by mail to the Suffolk County Office of Community Services at the address on the form, by fax, or by email.

About notarization

This document is signed and dated without a notary; if you use additional pages, print your name on each one, and no sworn attachment is specified.

How to submit this form

1
Download the Form
Download the Suffolk County Access to Services in Your Language Complaint Form.
2
Complete the Form
Print the form and provide your contact information, preferred language, details about the problem, and a specific description of what happened.
3
Add Any Extra Pages
Use additional pages if needed, and print your name on each sheet.
4
Sign and Send
Sign in black ink, date the form, and send it by mail, fax, or email using the contact information on the form.

Frequently asked questions

Do I need a notary for the Access to Services in Your Language Complaint Form?: No. The form asks you to sign and date your statement without a notary. If you use additional pages, print your name on each one.
How do I submit the language access complaint form?: Print and sign it with black ink, then send it by mail, fax, or email to the Suffolk County Office of Community Services using the contact details printed on the form.
What information does the complaint form ask for?: It asks for your contact details and preferred language, information about when and where the problem happened, and a specific description of what occurred.
Can someone help me file this complaint?: Yes. The form asks whether someone else is helping you file. If so, it requests that person's first and last name.

Need something notarized?

This Access to Services in Your Language Complaint Form doesn’t need a notary, but if you have another Suffolk County form that does, a commissioned online notary can help.