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 a person report language-access problems with Suffolk County public services or programs, such as not receiving an interpreter or receiving forms in a language they do not understand. It asks for contact details, preferred language, information about the problem and when and where it happened, and a signed statement. The form says the information will be kept confidential.
Who needs it
A person who experienced a language barrier while trying to use a Suffolk County service, program, or activity can complete this complaint form.
How to submit it
Print and sign the form in black ink, then mail, fax, or email it to the Suffolk County Office of Community Services at the address or contact details listed on the form.
About notarization
This complaint form is signed and dated without a notary; it identifies no attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download the Form
Download the Suffolk County language access complaint form.
- 2
Complete and Sign
Print in black ink, fill in the requested details, and sign and date the form.
- 3
Gather Any Extra Pages
If needed, add pages with details about what happened and print your name on each page.
- 4
Send It to the County
Mail, fax, or email the signed form to the Suffolk County Office of Community Services using the details on the form.
Frequently asked questions
- What does the language access complaint form report?
- Use it to describe a problem accessing a county service, program, or activity because of a language barrier, such as an unavailable interpreter or a form in a language you do not understand.
- Do I need a notary for the language access complaint form?
- No. The form asks you to sign and date your statement, but it does not require a notary or identify an attachment or related step that must be notarized or sworn.
- How do I submit the language access complaint form?
- Print and sign it in black ink, then mail, fax, or email it to the Suffolk County Office of Community Services using the address or contact details printed on the form.