Language Preference Form - Nyc Department Of Consumer Affairs
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1LANGUAGE PREFERENCE FORM
Julie Menin
Commissioner
Under New York City law, a business has the ability to indicate a language
42 Broadway
preference other than English for agency inspections. Use this form to submit
New York, NY 10004
your business’s language preference to the Department of Consumer Affairs
Dial 311
(DCA). Submit the form in ONE of the following ways:
(212-NEW-YORK)
Email
languagepreference@dca.nyc.gov
OR
Mail to: DCA Licensing Center, 42 Broadway, New York, NY 10004 OR
nyc.gov/consumers
Visit the DCA Licensing Center at the address above
Legal Name of Business:
Business Address:
DCA License/Record Number
(if available):
□ Yes
□ No
Do you prefer that business
inspections be in a language
other than English?
□ Arabic
□ Italian
If Yes, select one.
□ Bengali
□ Korean
□ Cantonese
□ Mandarin
□ Farsi
□ Polish
□ French
□ Russian
□ French-Creole
□ Spanish
□ Haitian Creole
□ Urdu
□ Hebrew
□ Vietnamese
□ Hindi
□ Other. Please specify:
____________________
___________________________
___________________________
Signature
Print Name
___________________________
___________________________
Title/Position (if any)
Date
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