What is the Suffolk County Language Access Complaint Form for?

Use this form to report problems accessing county services, programs, or activities because of language barriers, including interpreter or translated-document issues.

Do I need a notary for the Language Access Complaint Form?

No. The form has no notary block; the person filing certifies the statement is accurate and signs and dates it.

How do I submit the Language Access Complaint Form?

Complete it in black ink and send it by mail, fax, or email to the Community Services Office using the contact details printed on the form.

Suffolk County, NY · Suffolk County

No notary required

Accessing Services in Your Own Language Complaint Form

This Italian-language form lets Suffolk County residents report problems accessing county services, programs, or documents in their preferred language.

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

Use this form to tell Suffolk County about problems with language assistance, such as not being offered an interpreter, being denied one, or receiving documents in a language you do not understand. It asks for your contact and preferred-language information, details about what happened and when, and whether you already complained to a department or agency. The form says the information provided is confidential.

Who needs it

Suffolk County residents who experienced a language-access problem with county services, programs, activities, interpreters, or documents can submit this complaint form.

How to submit it

Print and complete the form in black ink, then send it by mail to the Community Services Office, H. Lee Dennison Building, 100 Veteran’s Memorial Hwy., Hauppauge, NY 11788; by fax to (631) 853-8271; or by email to [email protected].

About notarization

This complaint form is signed without a notary; the signer certifies the statement is accurate and signs and dates it.

How to submit this form

1
Download the Form
Download the Italian-language complaint form.
2
Complete the Form
Print in black ink and provide your contact information, preferred language, and details about the problem.
3
Add Relevant Details
Describe what happened and when, and include information about people involved if known. Add pages if needed.
4
Sign and Submit
Sign and date the form, then send it by mail, fax, or email to the Community Services Office.

Frequently asked questions

What is the Suffolk County Language Access Complaint Form for?: Use this form to report problems accessing county services, programs, or activities because of language barriers, including interpreter or translated-document issues.
Do I need a notary for the Language Access Complaint Form?: No. The form has no notary block; the person filing certifies the statement is accurate and signs and dates it.
How do I submit the Language Access Complaint Form?: Complete it in black ink and send it by mail, fax, or email to the Community Services Office using the contact details printed on the form.

Need something notarized?

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