Suffolk County, NY · Suffolk County
Accessing Services in Your Own 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 a person report a language-access problem involving Suffolk County 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 language details, information about the incident, and a description of what happened. The county says the information is confidential.
Who needs it
A person who experienced a language barrier while accessing a Suffolk County service or program can complete this complaint form.
How to submit it
Complete and sign the form in black ink, then mail it to the Suffolk County Office of Community Services at H. Lee Dennison Building, 100 Veteran’s Memorial Hwy., Hauppauge, NY 11788, fax it to (631) 853-8271, or email [email protected].
About notarization
This document is signed and dated without a notary; the signer certifies the statement is true to the best of their knowledge and belief.
How to submit this form
- 1
Download the Form
Download the Suffolk County Language Access Complaint Form.
- 2
Complete the Form
Print clearly and provide your contact details, preferred language, incident information, and a description of what happened.
- 3
Add Details if Needed
Use additional pages if necessary, and write your name on each page.
- 4
Sign and Submit
Sign in black ink and mail, fax, or email the form to the Suffolk County Office of Community Services.
Frequently asked questions
- Do I need a notary for the Language Access Complaint Form?
- No. The form asks the complainant to sign and date a statement that it is true to the best of their knowledge and belief; it does not require notarization.
- How do I submit the Language Access Complaint Form?
- Sign it in black ink and mail it to the Suffolk County Office of Community Services, fax it to (631) 853-8271, or email it to [email protected].
- What information does the complaint form request?
- It requests contact and preferred-language information, details about the language-access problem, when and where it happened, and a description of the incident.