Form Gen 1388 - Language Accessibility Services Complaint Form
Download a blank fillable Form Gen 1388 - Language Accessibility Services Complaint Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Gen 1388 - Language Accessibility Services Complaint Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2statE OF CaLIFOrnIa − hEaLth and huMan sErVICEs agEnCY
CaLIFOrnIa dEpartMEnt OF sOCIaL sErVICEs
LANGUAGE ACCESSIBILITY SERVICES COMPLAINT FORM
You have the right to free interpretive services and information translation in a timely manner. please use this form to report any
problem with access to language services you have experienced with the California department of social services.
return this form by mail to the Civil rights Bureau p.O. Box 944243, Ms 8-16-70 sacramento, Ca 94244-2430 or by fax
at (916) 653-9332. If you have any questions or concerns, contact us at (916) 654-2107; toll free 1 (866) 741-6241; or via
California relay service operator at 1 (800) 735-2929.
1. YOUR CONTACT INFORMATION
FIrst naME:
Last naME:
addrEss:
CItY:
statE:
zIp:
hOME/CELL nuMBEr:
EMaIL:
2. INTERPRETATION/TRANSLATION DETAILS
date of Incident:
___________________________________________________________
Cdss/program:
___________________________________________________________
Office address:
___________________________________________________________
did you know you have the right to free interpretive/translation services before this incident?
Yes
no
Incident:
In person
Letter
Email
Over the phone
In what language did you need assistance? _______________________________________
Language access Issue(s):
Lack of bilingual personnel
Lack of forms/materials in non-English languages
Lack of interpretive/translation services
Lack of signs informing the public of
interpretive/translation services
delay in receiving interpretive/translation services
Other: ___________________________________
Quality of interpretive/translation services
Brief description of Incident (attach additional pages if needed):
3. FORM ASSISTANCE
did someone assist with completing this form?
Yes (complete information below)
no (if no, leave blank)
FIrst naME:
Last naME:
OrganIzatIOn:
phOnE:
EMaIL:
I certify this statement is true to the best of my knowledge and belief.
sIgnaturE:
datE:
this form may be translated in another language upon request.
gEn 1388 (9/15)
pagE 1 OF 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal