Language Access Program Knowledge Center

LEP Individuals

Who is a Limited English Proficient (LEP) individual?


Individuals who do not speak English as their primary language and who have a limited ability to read, speak, write, or understand English are referred to as limited English proficient or LEP. These individuals may be entitled language assistance with respect to a particular type or service, benefit, or encounter.




What are the relevant laws concerning language access for LEP individuals?


Federal laws particularly applicable to language access include Title VI of the Civil Rights Act of 1964, and the Title VI regulations, prohibiting discrimination based on national origin, and Executive Order 13166 issued in 2000. Many individual federal programs, states, and localities also have provisions requiring language services for LEP individuals. See frequently asked question on these laws to learn more.




Which industries are required to provide language access programs for LEP individuals?


Any organizations, regardless of sizes or industry, may be required to comply with federal, state, or local government laws based on the nature and scope of their work. Government, healthcare, legal, and non-profit organizations are primarily affected by Title VI of 1964 Civil Rights Act and Executive Order 13166. See frequently asked question on these laws to learn more.




What are the standards types of services available for LEP individuals?


Interpretation – An interpreter is a person who verbally renders messages from the source language to the target. Interpretation can take place in-person, through a telephonic interpreter, or via internet or video interpreting. An interpreter must be competent and have knowledge in both languages of the relevant terms or concepts particular to the program or activity and the dialect and terminology used by the LEP individual. Depending upon the circumstances, language assistance services may call upon interpreters to provide simultaneous interpretation of proceedings so that an LEP person understands what is happening in that proceeding, or to interpret an interview or conversation with an LEP person in a consecutive fashion. Interpreter competency requires more than self-identification as bilingual. "Some bilingual staff and community volunteers, for instance, may be able to communicate effectively in a different language when communicating information directly in that language, but may not be competent to interpret in and out of English." Agencies should avoid using family members, children, friends, and untrained volunteers as interpreters because it is difficult to ensure that they interpret accurately and lack ethical conflicts. Translation is the replacement of written text from one language into another. A translator also must be qualified and trained. Federal agencies may need to identify and translate vital documents to ensure LEP individuals have meaningful access to important written information. Vital written documents include, but are not limited to, consent and complaint forms; intake and application forms with the potential for important consequences; written notices of rights; notices of denials, losses, or decreases in benefits or services; notice of disciplinary action; signs; and notices advising LEP individuals of free language assistance services. Agencies should proactively translate vital written documents into the frequently encountered languages of LEP groups eligible to be served or likely to be affected by the benefit program or service. Agencies should also put in place processes for handling written communication with LEP individuals in less frequently encountered languages




What is the standards for interpretation for LEP individuals?


The obligation to provide meaningful opportunity to individuals who are LEP is not limited to written translations. Oral communication between recipients and beneficiaries often is a necessary part of the exchange of information. Thus, a recipient that limits its language assistance to the provision of written materials may not be allowing LEP persons "effectively to be informed of or to participate in the program." There are a number of steps which can assist recipients and federal agencies in providing such oral assistance. They range from hiring bilingual staff or staff interpreters competent in the skill of interpreting, to contracting with qualified outside in-person or telephonic interpreter services, to arranging formally for the services of qualified voluntary community interpreters who are bound by confidentiality agreements. It is not acceptable for agencies or recipients to rely upon an LEP individual's family members or friends to provide the interpreter services. The agency or recipient should meet its obligations under EO 13166 or Title VI by supplying competent language services free of cost. In rare emergency situations, the agency or recipient may have to rely on an LEP person's family members or other persons whose language skills and competency in interpreting have not been established. Proper agency or recipient planning and implementation is important in order to ensure that those situations rarely occur.





Deaf/Hard of Hearing

Which laws relate to the deaf and hard of hearing?


Federal disability discrimination laws mandate equal access to and an equal opportunity to participate in and benefit from health care services, and effective communication with individuals who are deaf or hard of hearing. These laws include:. - Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794, requires programs which receive federal financial assistance to provide accommodations, such as qualified interpreters, real-time captioning (also called CART), assistive listening devices, or other auxiliary aids, to people with disabilities when necessary to ensure effective communication. See also 34 C.F.R. §§ 104.4 and 104.21. Examples of recipients to federal financial assistance include: health care providers who accept Medicaid or federal grants or any programs and activities offered by a school system, including school board meetings, extracurricular programs, teacher conferences, recreational activities, social and cultural activities, adult education, summer school or hobby classes. - Title II of the ADA, 42 U.S.C. §§ 12101-12213, requires comparable access by all state and local government programs, regardless of whether or not the programs get federal financial assistance. - Title II of the Americans with Disabilities Act – applies to all public (state and local) health care providers. - Title III of the Americans with Disabilities Act – applies to all private health care providers. These laws established a series of measures to prohibit instances of discrimination against individuals with disabilities by places of public accommodation (42 U.S.C. §§ 12181 – 12189). The key phrase used by the ADA when it comes to deaf and hard of hearing individuals is “effective communication." Whatever is necessary to ensure effective communication is required, by law, to be done. Although the details of what “effective communication" entails may be hazy in some cases, there’s no doubt that ultimately sign language interpreting is the most straightforward way for institutions to fulfill their obligations under the ADA.




What are the services required by the ADA Section 504?


Sign language interpreters - Sign language is used by many people who are deaf or hard of hearing. It is a visually interactive language that uses a combination of hand motions, body gestures, and facial expressions. There are several different types of sign language, including American Sign Language (ASL) and Signed English. Oral interpreters - Not all people who are deaf or hard of hearing are trained in sign language. Some individuals with hearing disabilities are trained in speech reading (lip reading) and can understand spoken words fairly well with assistance from an oral interpreter. Oral interpreters are specially trained to articulate speech silently and clearly, sometimes rephrasing words or phrases to give higher visibility on the lips. Natural body language and gestures are also used. Cued speech interpreters - A cued speech interpreter functions in the same manner as an oral interpreter except that he or she also uses a hand code, or cue, to represent each speech sound. Computer Assisted Real-time Transcription (CART) - Many people who are deaf or hard of hearing are not trained in either sign language or speech reading. CART is a service in which an operator types what is said into a computer that displays the typed words on a screen.




Who must comply with the ADA and related laws?


The ADA extends beyond medical settings to other areas such as legal, education, law enforcement and employment systems. For example, if a company is interviewing a deaf individual, for instance, they are required to provide sign language interpreting. Similarly, hard of hearing defendants in a legal proceeding must be provided with an interpreter. The ADA even covers the hospitality industry. For example, hotels must meet hard of hearing communication needs by providing a teletypewriter — the device hard of hearing persons need to use a telephone — to guest rooms upon request, and they must also have a teletypewriter available at the front desk. One extremely important area covered by the ADA is the medical field, where sign language interpreting services are often required. Hospitals, for instance, must provide an appropriate means of communication to any patients, family members or hospital visitors who may be hearing impaired. This is applicable in all hospital areas, from the emergency room to the gift shop. In some cases, the ADA specifies that an effective form of communication may consist simply of a written note, but if a conversation is more complicated — such as explaining a patient’s symptoms or a medical procedure — a qualified ASL interpreter may be necessary.




Are private health care providers required to comply with ADA regulations?


Yes. Private health care providers are considered places of public accommodation (42 U.S.C. §§ 12181 – 12189). Title III of the ADA applies to all private health care providers, regardless of the size of the office or the number of employees. 28 C.F.R. § 36.104. It applies to providers of both physical and mental health care. Hospitals, nursing homes, psychiatric and psychological services, offices of private physicians, dentists, health maintenance organizations (HMOs), and health clinics are included among the health care providers covered by the ADA. If a professional office of a doctor, dentist, or psychologist is located in a private home, the portion of the home used for public purposes (including the entrance) is considered a place of public accommodation (28 C.F.R. § 36.207). The analysis to this regulation is at 56 Fed. Reg. 35544 (July 26, 1991). Specifically, it states: “No individual shall be discriminated against on the basis of disability in the full and equal enjoyment of the goods, services, facilities, privileges, advantages, or accommodations of any place of public accommodation by any person who owns, leases (or leases to), or operates a place of public accommodation." Additionally, discrimination includes: "…a failure to take such steps as may be necessary to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently than other individuals because of the absence of auxiliary aids and services…" The ADA definition of “auxiliary aids and services" includes “qualified interpreters or other effective methods of making aurally delivered materials available to individuals with hearing impairments." Therefore, any place of public accommodation is required to provide sign language interpreters or other effective means of communication for hard of hearing individuals. Depending on the situation, other effective means of communication may include assistive listening devices.




What is the obligation of health care providers under the ADA for individuals who are deaf or hard of hearing?


Health care providers have a duty to provide appropriate auxiliary aids and services when necessary to ensure that communication with people who are deaf or hard of hearing is as effective as communication with others. 28 C.F.R. § 36.303(c).




Is this obligation limited to deaf or hard of hearing patients?


No. A health care provider must communicate effectively with customers, clients, and other individuals who are deaf or hard of hearing who are seeking or receiving its services. 56 Fed. Reg. at 35565. Such individuals may not always be “patients" of the health care provider. For example, if prenatal classes are offered as a service to both fathers and mothers, a father who is deaf or hard of hearing must be provided auxiliary aids or services to ensure that he has the same opportunity to benefit from the classes as would other fathers. Similarly, a deaf parent of a hearing child may require an auxiliary aid or service to communicate effectively with health care providers, participate in the child’s health care, and to give informed consent for the child’s medical treatment. Classes, support groups, and other activities that are open to the public must be also be accessible to deaf and hard of hearing participants.




What kinds of auxiliary aids and services are required by the ADA to ensure effective communication with deaf or hard of hearing individuals?


Auxiliary aids and services include equipment or services a person needs to access and understand aural information and to engage in effective communication. For example, the rule includes qualified interpreters, computer-aided transcription services (also called CART), written materials, assistive listening devices, captioning, or other effective methods of making aural information and communication accessible. 28 C.F.R. § 303(b)(1).




How does a health care provider determine which auxiliary aid or service to provide for a patient who is deaf or hard of hearing?


The auxiliary aid and service requirement is flexible, and the health care provider can choose among various alternatives as long as the result is effective communication with the deaf or hard of hearing individual. An individual who is deaf or hard of hearing likely has experience with auxiliary aids and services to know which will achieve effective communication with his or her health care provider. The U.S. Department of Justice expects that the health care provider will consult with the person and consider carefully his or her self-assessed communication needs before acquiring a particular auxiliary aid or service. 56 Fed. Reg. at 35566-67.




Why are auxiliary aids and services so important in medical settings?


Auxiliary aids and services are often needed to provide safe and effective medical treatment. Without these auxiliary aids and services, medical staff run the grave risk of not understanding the patient’s symptoms, misdiagnosing the patient’s medical problem, and prescribing inadequate or even harmful treatment. Similarly, patients may not understand medical instructions and warnings or prescription guidelines.




Are there any limitations on the ADA’s auxiliary aids and services requirements?


Yes. The ADA does not require the provision of any auxiliary aid or service that would result in an undue burden or in a fundamental alteration in the nature of the goods or services provided by a health care provider. 28 C.F.R. § 36.303(a). Making information or communication accessible to an individual who is deaf or hard of hearing is unlikely ever to be a fundamental alteration of a health care service. An individualized assessment is required to determine whether a particular auxiliary aid or service would be an undue burden.




When would providing an auxiliary aid or service be an undue burden?


An undue burden is something that involves a significant difficulty or expense. For example, it might be a significant difficulty to obtain certain auxiliary aids or services on short notice. Factors to consider in assessing whether an auxiliary aid or service would constitute a significant expense include the nature and cost of the auxiliary aid or service; the overall financial resources of the health care provider; the number of the provider’s employees; the effect on expenses and resources; legitimate safety requirements; and the impact upon the operation of the provider. 28 C.F.R. § 36.104. Showing an undue burden may be difficult for most health care providers. When an undue burden can be shown, the health care provider still has the duty to furnish an alternative auxiliary aid or service that would not result in an undue burden and, to the maximum extent possible, would ensure effective communication. 28 C.F.R. § 36.303(f).




Must a health care provider pay for an auxiliary aid or service for a medical appointment if the cost exceeds the provider’s charge for the appointment?


In some situations, the cost of providing an auxiliary aid or service (e.g., a qualified interpreter) may exceed the charge to the patient for the health care service. A health care provider is expected to treat the costs of providing auxiliary aids and services as part of the overhead costs of operating a business. Accordingly, so long as the provision of the auxiliary aid or service does not impose an undue burden on the provider’s business, the provider is obligated to pay for the auxiliary aid or service.




Can a health care provider charge a deaf or hard of hearing patient for part or all of the costs of providing an auxiliary aid or service?


No. A health care provider cannot charge a patient for the costs of providing auxiliary aids and services. 28 C.F.R. § 36.301(c).




Who is qualified to be an interpreter in a health care setting?


A qualified interpreter is an interpreter who is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary. 28 C.F.R. § 36.104. Interpreters providing services in a medical setting may need to be able to interpret medical terminology.




Do all individuals who are deaf or hard of hearing use the same kind of interpreter?


No. There are various kinds of interpreters. The health care provider should ascertain the particular language needs of the person who is deaf or hard of hearing prior to hiring an interpreter. Some individuals may require interpreters who are fluent in American Sign Language, a language with grammar and syntax that is different from the English language. Others may require interpreters who use Signed English, a form of signing which uses the same word order as does English. Still others who do not know any sign language may require oral interpreters, who take special care to articulate words for deaf or hard of hearing individual, or cued speech interpreters, who give visual cues to assist in lip reading (also called speech reading).




Can a health care provider require family members or friends to interpret for deaf or hard of hearing patients?


Generally, no. Family members and friends often do not possess sufficient skills to interpret effectively in a medical setting. Family members and friends are also very often too emotionally or personally involved, may have interests that conflict with the patient’s, may cause role confusion, and are unable to interpret “effectively, accurately, and impartially."Finally, using family members and friends as interpreters can cause problems in maintaining patient confidentiality. 56 Fed. Reg. at 35553.




In what medical situations should a health care provider obtain the services of a qualified interpreter?


An interpreter should be present in all situations in which the information exchanged is sufficiently lengthy or complex to require an interpreter for effective communication. Examples may include, but are not limited to, discussing a patient’s medical history, obtaining informed consent and permission for treatment, explaining diagnoses, treatment, and prognoses of an illness, conducting psychotherapy, communicating prior to and after major medical procedures, providing complex instructions regarding medication, explaining medical costs and insurance, and explaining patient care upon discharge from a medical facility.




Is lipreading an effective form of communicating with individuals who are deaf or hard of hearing?


Not often. The ability of a deaf or hard of hearing individual to speak clearly does not mean that he or she can hear well enough to understand spoken communication or to lipread effectively. Forty to 60 percent of English sounds look alike when spoken. On average, even the most skilled lipreaders understand only 25 percent of what is said to them, and many individuals understand far less. Lipreading is most often used as a supplement to the use of residual hearing, amplification, or other assistive listening technology. Because lipreading requires some guesswork, very few deaf or hard of hearing people rely on lipreading alone for exchanges of important information. Lipreading may be particularly difficult in the medical setting where complex medical terminology is often used. Individuals who are deaf or hard of hearing who rely on lipreading for communication may need an oral interpreter to ensure effective communication.




Do written notes offer an effective means of communicating with deaf and hard of hearing individuals?


Exchanging written notes may be effective for brief and simple communication. Communication through the exchange of written notes is inherently truncated; information that would otherwise be spoken may not be written. Moreover, written communication can be slow and cumbersome. If a health care provider is communicating less or providing less information in writing than he or she would provide when speaking to a patient, this is an indication that writing to communicate is not effective in that context. Understanding written material may also depend on the reading level or literacy skills of the individual. The reading level of deaf and hard of hearing individuals is as variable as the reading levels found in the general population. Additionally, for some deaf and hard of hearing people, American Sign Language (ASL) is their first language. Because the grammar and syntax of ASL differs considerably from English, exchanging written notes may not provide effective communication between a deaf or hard of hearing patient and a health care provider. For some deaf or hard of hearing individuals, the services of a qualified sign language interpreter offer the only effective method of communication.




Must health care providers make conferences, health education, and training sessions that are open to the general public accessible to deaf and hard of hearing individuals?


Yes. Health care providers that offer training sessions, health education, or conferences to the general public must make these events accessible to deaf and hard of hearing individuals. See generally 28 C.F.R. §§ 36.201 and 36.202. Qualified interpreters, computer-assisted transcription services (also called CART), assistive listening systems/devices, or other auxiliary aids or services may be necessary to ensure equal access to and an equal opportunity to participate for deaf and hard of hearing attendees.




What are the penalties for Non-Compliance?


According to ADA standards, it is usually up to the institution in question to provide — and pay for — any necessary sign language interpreting. If an institution does not comply by providing effective communication, such as an ASL interpreter, it may suffer serious penalties. In a 2008 disability discrimination and punitive damages case, a deaf woman successfully sued a New Jersey doctor who refused to provide her with a sign language interpreter after she asked for one on multiple occasions. The jury agreed that this qualified as discrimination and ruled unanimously in favor of a $400,000 award. Wal-Mart has also been faced with disability discrimination complaints. In 2000, the mega retailer settled a case for $135,500, brought by two deaf individuals who had applied for jobs at a Wal-Mart in Tucson, Arizona. The lawsuit was brought under the ADA. As part of the settlement, Wal-Mart agreed to provide sign language interpreting to both individuals during their training and orientation, as well as during any scheduled meetings and work evaluations.




Can health care providers receive any tax credits for the costs of providing auxiliary aids and services?


Eligible businesses may claim a tax credit for eligible access expenditures. Please consult with your financial or tax advisor on this issue.





Title VI of 1964 CRA

Why are LEP individuals protected from national origin discrimination under Title VI?


The Supreme Court decided over three decades ago that a federal fund recipient’s denial of an education to a group of non-English speakers violated Title VI and its implementing regulations. Lau v. Nichols, 414 U.S. 563, 569 (1974). As the Court explained, “[i]t seems obvious that the Chinese-speaking minority receive fewer benefits than the English-speaking majority from respondents’ school system which denies them a meaningful opportunity to participate in the educational program—all earmarks of the discrimination banned by” Title VI regulations. Id. at 568; see also id. at 570-71 (Stewart, J., concurring in result).




Does the failure by a recipient to provide meaningful access to LEP persons constitute national origin discrimination?


Since the Supreme Court’s decision in Lau, other courts have found that the failure by a recipient to provide meaningful access to LEP persons constitutes national origin discrimination. See, e.g., Sandoval v. Hagan, 197 F.3d 484, 510-11 (11th Cir. 1999) (holding that English-only policy for driver’s license applications constituted national origin discrimination under Title VI), rev’d on other grounds, 532 U.S. 275 (2001); Almendares v. Palmer, 284 F. Supp. 2d 799, 808 (N.D. Ohio 2003) (holding that allegations of failure to ensure bilingual services in a food stamp program could constitute a violation of Title VI).




What are the types of language assistance services available?


There are two primary types of language assistance services: oral and written.

- Oral language assistance service may come in the form of "in-language" communication (a demonstrably qualified bilingual staff member communicating directly in an LEP person's language) or interpreting. Interpretation can take place in-person, through a telephonic interpreter, or via internet or video interpreting. An interpreter is a person who renders a message spoken in one language into one or more languages. An interpreter must be competent and have knowledge in both languages of the relevant terms or concepts particular to the program or activity and the dialect and terminology used by the LEP individual. Depending upon the circumstances, language assistance services may call upon interpreters to provide simultaneous interpretation of proceedings so that an LEP person understands what is happening in that proceeding, or to interpret an interview or conversation with an LEP person in a consecutive fashion. Interpreter competency requires more than self-identification as bilingual. "Some bilingual staff and community volunteers, for instance, may be able to communicate effectively in a different language when communicating information directly in that language, but may not be competent to interpret in and out of English." Agencies should avoid using family members, children, friends, and untrained volunteers as interpreters because it is difficult to ensure that they interpret accurately and lack ethical conflicts. - Translation is the replacement of written text from one language into another. A translator also must be qualified and trained. Federal agencies may need to identify and translate vital documents to ensure LEP individuals have meaningful access to important written information. Vital written documents include, but are not limited to, consent and complaint forms; intake and application forms with the potential for important consequences; written notices of rights; notices of denials, losses, or decreases in benefits or services; notice of disciplinary action; signs; and notices advising LEP individuals of free language assistance services. Agencies should proactively translate vital written documents into the frequently encountered languages of LEP groups eligible to be served or likely to be affected by the benefit program or service. Agencies should also put in place processes for handling written communication with LEP individuals in less frequently encountered languages




Do Department of Justice (DOJ) Title VI implementing regulations prohibit both intentional discrimination and practices that have a discriminatory impact?


Yes. DOJ’s Title VI implementing regulations prohibit not only intentional discrimination but also facially-neutral practices that have a discriminatory impact, see 28 C.F.R. 42.104(b)(2). The “failure to ensure that LEP persons can effectively participate in or benefit from Federally assisted programs and activities” may constitute national origin discrimination. U.S. Dept. of Justice, Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Persons, 67 Fed. Reg. 41,455, 41,457 (June 18, 2002).




Why is it important to have a Language Access Implementation Plan, Policy Directives, and Procedures in place?


- A Language Access Implementation Plan helps management and staff understand their roles and responsibilities with respect to overcoming language barriers for LEP individuals. The plan is a management document that outlines how the agency has or will define language assistance tasks, set deadlines and priorities, assign responsibility, and allocate the resources necessary to come into or maintain compliance with language access requirements. It describes how the agency will effectuate the service delivery standards delineated in the policy directives, including the manner by which it will address the language service and resource needs identified in a self-assessment. - Language Policy Directives set forth standards, operating principles, and guidelines that govern the delivery of language appropriate services. Policy directives may come in different forms but are designed to require the agency and its staff to ensure meaningful access. Policy directives should be made publicly available. - Language Access Procedures are the "how to" for staff. They specify for staff the steps to follow to provide language services, gather data, and deliver services to LEP individuals. Procedures can be set forth in handbooks, intranet sites, desk references, reminders at counters, notations on telephone references, and the like.




Who should be trained to access and manage language services:


All personnel that may interact with LEP individuals should be aware of the appropriate procedures. Staff will not be able to provide meaningful access to LEP individuals if they do not receive training on language access policies and procedures, including how to access language assistance services. For policies and procedures to be effective, new and existing staff should periodically receive training on the content of the language access policy, identifying language access needs, and providing language assistance services to LEP individuals. This staff training should be mandatory for staff who have the potential to interact or communicate with LEP individuals, staff whose job it is to arrange for language support services, and managers. Training should include making procedures clear and readily available to ensure seamless provision of language assistance services.




Why is it important to modify or update your Language Access Implementation Plan and related Language Access Procedures?


- In his Memorandum for Heads of Federal Agencies regarding the Federal Government's Renewed Commitment to Language Access Obligations Under Executive Order 13166, the Attorney General asked each federal agency to evaluate and/or update your current response to LEP needs by, among other things, conducting an inventory of languages most frequently encountered, identifying the primary channels of contact with LEP community members (whether telephonic, in person, correspondence, web-based, etc.), and reviewing agency programs and activities for language accessibility. - Agencies may need to update program operations, services provided, outreach activities, and other mission-specific activities to reflect current language needs. For example, changes in demographics, types of services provided, or the economy may impact the number and languages spoken by LEP individuals who participate in your agency's program or activities. - Agencies should, where appropriate, have a process for determining, on an ongoing basis, whether new documents, programs, services, and activities need to be made accessible for LEP individuals, and they may want to provide notice of any changes in services to the LEP public and to employees. - Each agency should establish a schedule to periodically evaluate and update agency LEP services and LEP policies, plans, and protocols. At a minimum, periodic reviews should occur on a biannual basis.




Why is it important to monitor the effectiveness of your Language Access Implementation Plan?


- It is important to monitor the effectiveness of your Language Access Implementation Plan in order to ensure that LEP individuals have meaningful access to agency programs or activities. As some strategies may prove more effective than others, ongoing monitoring can help an agency fine-tune the provision of language assistance services and can potentially realize cost-savings over time. - Monitoring the effectiveness of your Plan may include: - Analyzing current and historical data on language assistance usage, including languages served; Observing the provision of language assistance services through audits or testing; - Surveying staff on how often they use language assistance services, if they believe there should be changes in the way services are provided or the providers that are used, and if they believe that the language assistance services in place are meeting the needs of the LEP communities in your service area; - Conducting customer satisfaction surveys of LEP applicants and beneficiaries based on their actual experience of accessing the agency's programs, benefits or services; - Soliciting feedback from community-based organizations and other stakeholders about the agency's effectiveness and performance in ensuring meaningful access for LEP individuals; - Updating community demographics and needs by engaging school districts, faith communities, refugee resettlement agencies, and other local resources; - Considering new resources including funding, collaborations with other agencies, human resources, and other mechanisms for ensuring improved access for LEP individuals; - Monitoring your agency's response rate to complaints or suggestions by LEP individuals, community members and employees regarding language assistance services provided.




Why is it important to track the number of LEP individuals that your agency has served or who have participated in your program or activity:


- Creating a record of language assistance services can help inform agencies with respect to whether there should be changes to the quantity or type of language assistance services. For instance, agencies may decide to hire qualified bilingual staff for positions in which there is a high-incidence language need. - Agencies should keep a record of the number of LEP individuals served, the primary language spoken by each LEP person encountered, and the type of language assistance provided (oral or written) during each encounter, if any. - Procurement offices should also consider preparing for management an annual estimate of the cost of translation and interpretation services within the agency. This will help management ensure that resources are appropriately allocated to the most critical programs, geographic areas, or languages.




What impact does Title VI have on court interpretation?


Many state and local court systems receive direct or indirect financial assistance from the Department of Justice or another federal agency. Recipients of such federal financial assistance must comply with Title VI of the Civil Rights Act of 1964, as amended, 42 U.S.C. § 2000, et seq, and its implementing regulations, which prohibit discrimination on the basis of race, color, and national origin in programs that receive federal financial assistance. Under Executive Order 13166, reprinted at 65 FR 50121 (August 16, 2000), each federal agency that extends federal financial assistance is required to issue guidance explaining the obligations of their recipients to ensure meaningful access by LEP persons to their federally assisted programs and activities. On June 18, 2002, the Department of Justice issued final guidance to its recipients regarding the requirement to take reasonable steps to provide meaningful access to LEP individuals. (67 FR 41455). The DOJ Guidance outlines four factors that should be considered to determine when language assistance might be required to ensure such meaningful access, and it identifies cost effective measures to address those language needs. Those factors are: 1. The number or proportion of LEP persons in the eligible service population; 2. The frequency with which LEP individuals come into contact with the program; 3. The importance of the program or activity to the LEP person (including the consequences of lack of language services or inadequate interpretation/translation); and 4. The resources available to the recipient and the costs. DOJ’s Guidance focuses on a huge range of types of recipients. The consequences of lack of access to some of these programs is much greater than others. The Guidance was written for, and intended to apply flexibly to, everything from bicycle safety courses to criminal trials, and even to serve as a model for the enormous variety of recipients of funds from other federal agencies. In this context, nearly every encounter an LEP person has with a court is of great importance or consequence to the LEP person. Thus, the guidance emphasizes the need for courts to provide language services free of cost to LEP persons. Court interactions are amongst the most important interactions an LEP person may have. While we recognize that resources are a concern across every court system, and that increasing access can be a process that takes some time, we note that the LEP Guidance was issued in 2002. Moreover, the Supreme Court articulated the need to provide meaningful access to LEP persons twenty-eight years earlier in Lau v. Nichols. With the passing of time, the need to show progress in providing all LEP persons with meaningful access is amplified. The DOJ Guidance states: ... [W]hen oral language services are necessary, recipients [of any federal funds] should generally offer competent interpreter services free of cost to the LEP person. For DOJ recipient programs and activities, this is particularly true in a courtroom, administrative hearing, pre- and post-trial proceedings, situations in which health, safety, or access to important benefits and services are at stake, or when credibility and accuracy are important to protect an individual's rights and access to important services (67 FR 41455, 41462). Charging LEP persons for interpreter costs or failing to provide interpreters can implicate national origin discrimination concerns. DOJ’s Guidance goes on to note: ...At a minimum, every effort should be taken to ensure competent interpretation for LEP individuals during all hearings, trials, and motions during which the LEP individual must and/or may be present. (67 FR 41455, 41471) Examples of Title VI compliance can be found in states in which courts are providing interpretation free of cost to all LEP persons encountering the system (including parents of non-LEP minors), whether it be in a criminal or civil setting, and in important interactions with court personnel, as well as providing translations of vital documents and signage. Many states are moving in this direction. The Federal Coordination and Compliance Section (FCS) of the Civil Rights Division works with court systems and consortia to provide outreach on compliance and best practices to all state courts, and to provide technical assistance. FCS also conducts investigations into allegations of national origin discrimination in courts.





Executive Order 13166

What is Executive Order 13166?


An Executive Order is an order given by the President to federal agencies. The LEP Executive Order (Executive Order 13166) says that people who are LEP should have meaningful access to federally conducted and federally funded programs and activities. On August 11, 2000, the President signed Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency." The Executive Order requires Federal agencies to examine the services they provide, identify any need for services to those with limited English proficiency (LEP), and develop and implement a system to provide those services so LEP persons can have meaningful access to them. It is expected that agency plans will provide for such meaningful access consistent with, and without unduly burdening, the fundamental mission of the agency. The Executive Order also requires that the Federal agencies work to ensure that recipients of Federal financial assistance provide meaningful access to their LEP applicants and beneficiaries. To assist Federal agencies in carrying out these responsibilities, the U.S. Department of Justice has issued a Policy Guidance Document, "Enforcement of Title VI of the Civil Rights Act of 1964 - National Origin Discrimination Against Persons With Limited English Proficiency" (LEP Guidance). This LEP Guidance sets forth the compliance standards that recipients of Federal financial assistance must follow to ensure that their programs and activities normally provided in English are accessible to LEP persons and thus do not discriminate on the basis of national origin in violation of Title VI's prohibition against national origin discrimination. The Federal Coordination and Compliance Section (FCS) is responsible for government-wide coordination with respect to Executive Order 13166. FCS serves as the federal repository for the internal implementation plans that each federal agency is required to develop, to ensure meaningful access to its own federally conducted programs and activities, and it also reviews and approves each funding agency’s external LEP guidance for its recipients. As the Department of Justice prepared its own plan, FCS staff reviewed and approved each component’s submission. Further, FCS staff developed the Department’s external guidance for its own recipients. FCS has initiated an aggressive program of intra- and inter-agency consultations and actively solicits comments and suggestions from representatives of recipient and LEP individuals on how to identify and address the needs of LEP individuals under Executive Order 13166 in an effective and cost-effective manner.




What is a recipient of federal financial assistance?


Federal financial assistance includes grants, training, use of equipment, donations of surplus property, and other assistance. Subrecipients are also covered, when federal funds are passed from one recipient to a subrecipient. Recipients of federal funds range from state and local agencies, to nonprofits and other organizations. A list of the types of recipients and the agencies funding them can be found at Executive Order 12250 Coordination of Grant-Related Civil Rights Statutes. Title VI covers a recipient's entire program or activity. This means all parts of a recipient's operations are covered. This is true even if only one part of the recipient receives the federal assistance. Example: DOJ provides assistance to a state department of corrections to improve a particular prison facility. All of the operations of the entire state department of corrections--not just the particular prison--are covered. More information on Title VI, generally, can be found at Title VI of the Civil Rights Act of 1964 42 U.S.C. § 2000d et seq.




What are recipients of federal funds and federal agencies required to do to meet LEP requirements?


Recipients and federal agencies are required to take reasonable steps to ensure meaningful access to their programs and activities by LEP persons. While designed to be a flexible and fact-dependent standard, the starting point is an individualized assessment that balances the following four factors: 1. The number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee; 2. the frequency with which LEP individuals come in contact with the program; 3. the nature and importance of the program, activity, or service provided by the program to people's lives; and 4. the resources available to the grantee/recipient or agency, and costs. As indicated above, the intent of this guidance is to find a balance that ensures meaningful access by LEP persons to critical services while not imposing undue burdens on small business, or small nonprofits.




Do recipients of federal funds have to submit written language access plans to the Department of Justice or to their federal funding agency each year?


No. While planning is an important part of ensuring that reasonable steps are taken to provide meaningful access to LEP individuals seeking services, benefits, information, or assertion of rights, there is no blanket requirement that the plans themselves be submitted to federal agencies providing federal financial assistance. In certain circumstances, such as in complaint investigations or compliance reviews, recipients may be required to provide to federal agencies a copy of any plan created by the recipient.




When developing plans and guidance regarding translation of documents, how do we determine which documents must be translated?


It is important to ensure that written materials routinely provided in English also are provided in regularly encountered languages other than English. It is particularly important to ensure that vital documents are translated into the non-English language of each regularly encountered LEP group eligible to be served or likely to be affected by the program or activity. A document will be considered vital if it contains information that is critical for obtaining federal services and/or benefits, or is required by law. Vital documents include, for example: applications, consent and complaint forms; notices of rights and disciplinary action; notices advising LEP persons of the availability of free language assistance; prison rulebooks; written tests that do not assess English language competency, but rather competency for a particular license, job, or skill for which English competency is not required; and letters or notices that require a response from the beneficiary or client. For instance, if a complaint form is necessary in order to file a claim with an agency, that complaint form would be vital. Non-vital information includes documents that are not critical to access such benefits and services. Advertisements of federal agency tours and copies of testimony presented to Congress that are available for information purposes would be considered non-vital information.
Vital documents must be translated when a significant number or percentage of the population eligible to be served, or likely to be directly affected by the program/activity, needs services or information in a language other than English to communicate effectively. For many larger documents, translation of vital information contained within the document will suffice and the documents need not be translated in their entirety. It may sometimes be difficult to draw a distinction between vital and non-vital documents, particularly when considering outreach or other documents designed to raise awareness of rights or services. Though meaningful access to a program requires an awareness of the program's existence, we recognize that it would be impossible, from a practical and cost-based perspective, to translate every piece of outreach material into every language. Title VI does not require this of recipients of federal financial assistance, and EO 13166 does not require it of federal agencies. Nevertheless, because in some circumstances lack of awareness of the existence of a particular program may effectively deny LEP individuals meaningful access, it is important for federal agencies to continually survey/assess the needs of eligible service populations in order to determine whether certain critical outreach materials should be translated into other languages.




Does Executive Order 13166 apply to materials on websites?


Yes. However, the decision to place something on the web will not affect whether the document must be translated. For example, placement on the website should not change the agencies’ or recipients’ original assessment regarding the number or proportion of LEP persons that comprise the intended audience for that document. The four-factor analysis applies to each individual "document" on the website. Generally, entire websites need not be translated, as only the vital information within the website might need translation. If, in applying the four-factor analysis, the agency or recipient determines that a particular document/piece of information should be translated, that translation should also be posted on the website if the English-language version is on the website. If documents are translated within a website, the existence of the translation should be noted (in the appropriate language) at an initial entry point to the site (usually the homepage).




What do recipients of federal financial assistance do if they are operating in a state or locality that has an English-only or official English law that requires the use of English in communications?


All recipients of federal funds and all federal agencies are required by law to take reasonable steps to provide meaningful access to limited English proficient persons. This means that, even if recipients operate in jurisdictions in which English has been declared the official language under state or local law, these recipients continue to be subject to federal nondiscrimination requirements, including those applicable to the provision of federally assisted services to persons with limited English proficiency. All recipients should be aware that despite the state's or local jurisdiction’s official English law, Title VI and the Title VI regulations apply. Thus, recipients must provide meaningful access for LEP persons. State and local laws may provide additional obligations to serve LEP individuals, but cannot compel recipients of federal financial assistance to violate Title VI. For instance, given our constitutional structure, state or local "English - only" or official English laws do not relieve an entity that receives federal funding from its responsibilities under federal nondiscrimination laws. Entities in states and localities with "English - only" or official English laws are certainly not required to accept federal funding – but if they do, they have to comply with Title VI, including its prohibition against national origin discrimination by recipients of federal assistance. Failing to make federally assisted programs and activities accessible to individuals who are LEP may violate Title VI and the Title VI regulations.




Does the Executive Order 13166 apply to federally conducted activities overseas or to foreign recipients of federal financial assistance?


No. The Department of Justice has determined that EO 13166 applies only within the United States and its territories and does not apply extraterritorially. However, agencies that conduct activities overseas must still submit a plan for making their domestic activities accessible to people who are limited English proficient. That plan should indicate that the agency conducts federal activities abroad, but that DOJ has determined that the EO does not apply to those activities. Similarly, agencies that provide federal financial assistance abroad and domestically must still create guidance for their domestic recipients, and may include a statement in the guidance indicating that the guidance does not apply extraterritorially.




Does Executive Order 13166 require that bids be let in languages other than English?


Generally, current practice with regard to announcing federal government contracts and grants would not be altered under the Executive Order. In determining what is required, the focus of the analysis in this situation is on the first factor – the number or proportion of eligible LEP persons. Except, perhaps, in territories, it is reasonable to expect that the number or proportion of eligible contract or grant recipients who are LEP and are themselves attempting to find and respond to announcements of grants and contracts is negligible.




If a federal agency contracts with a private or other entity to conduct certain activities of the agency, does the Executive Order apply to the activities of the contractor?


Yes. When a different entity conducts certain activities for the federal agency, then the Executive Order applies to the entity's activities. The agency should ensure that the entity knows the general standards for LEP access and applies the agency's plan to the activities it is conducting on behalf of the agency. An agency cannot avoid its obligations by contracting them out. Mandatory compliance with the agency’s LEP policy should be included in the contract.




Where can I get a copy of the Executive Order and the DOJ General LEP Guidance?


A copy of the Executive Order and DOJ's general LEP Guidance (both translated into Spanish and Chinese) can be found on the Federal Coordination and Compliance Section website at https://www.justice.gov/crt/executive-order-13166. For more information on Executive Order 13166, please contact the Federal Coordination and Compliance Section, 202-307-2222.





ACA's Section 1557

What is Section 1557?


Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). The law prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in health programs or activities that receive Federal financial assistance or are administered by an Executive agency or any entity established under Title I of the ACA. Section 1557 has been in effect since enactment of the ACA.




How does Section 1557 protect consumers?


Section 1557 makes it unlawful for any health care provider that receives funding from the Federal government to refuse to treat an individual – or to otherwise discriminate against the individual – based on race, color, national origin, sex, age or disability. Section 1557 imposes similar requirements on health insurance issuers that receive federal or state financial assistance. Health care providers and insurers are barred, among other things, from excluding or adversely treating an individual on any of these prohibited bases. The Section 1557 final rule applies to recipients of financial assistance from the Department of Health and Human Services (HHS), the Health Insurance Marketplaces and health programs administered by HHS.




How are covered entities under Section 1557 supposed to let consumers know about their rights?


The final rule requires all covered entities to post a notice of consumer civil rights; covered entities with 15 or more employees are also required to have a civil rights grievance procedure and an employee designated to coordinate compliance. Under a new requirement, covered entities are required to post information telling consumers about their rights and telling consumers with disabilities and consumers with limited English proficiency (LEP) about the right to receive communication assistance. They are also required to post taglines in the top 15 languages spoken by individuals with LEP in the states in which the covered entity operates, advising consumers of the availability of free language assistance services.




What does the final rule of Section 1557 require for individuals with limited English proficiency (LEP)?


The final rule adopts the longstanding civil rights principle that covered entities must take reasonable steps to provide meaningful access to each individual with LEP. The standards incorporated into the final rule are flexible and context-specific, taking into account factors such as the nature and importance of the health program and the communication at issue and other relevant considerations, such as whether an entity has developed and implemented an effective language access plan appropriate to its circumstances.




What does the final rule of Section 1557 require concerning individuals with disabilities?


The final rule is consistent with existing directives implementing the requirements under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act of 1973. It requires effective communication, including through the provision of auxiliary aids and services; establishes standards for accessibility of buildings and facilities; requires that health programs provided through electronic and information technology be accessible; and requires covered entities to make reasonable modifications to their policies, procedures, and practices to provide individuals with disabilities access to a covered entity’s health programs and activities.




What steps can be taken when an individual believes that his or her civil rights have been violated under Section 1557?


If you feel that you or someone you know has been subject to discrimination in health care or health coverage, you may file a complaint of discrimination under Section 1557. Please visit OCR’s website at www.hhs.gov/ocr to file a complaint or to request a complaint package, or call OCR’s toll free number at (800) 368-1019 or (800) 537-7697 (TDD) to speak with someone who can answer your questions and guide you through the process. OCR’s complaint forms are available in a variety of languages. Individuals can also file lawsuits under Section 1557.




How is the final rule under Section 1557 different from rules under the other civil rights laws the Office for Civil Rights already enforces?


The final rule is consistent with existing, well-established Federal civil rights laws and clarifies the standards HHS will apply in implementing Section 1557 of the ACA. These standards provide that individuals cannot be denied access to health care or health coverage or otherwise be subject to discrimination because of race, color, national origin, sex, age, or disability. Building on long-standing and familiar civil rights principles, the final rule is an important step toward eliminating unlawful discrimination in federally funded programs and HHS programs. Section 1557 is the first Federal civil rights law to broadly prohibit discrimination on the basis of sex in all federally funded health care programs. The final rule extends nondiscrimination protections to individuals enrolled in coverage through the Health Insurance Marketplaces and certain other health coverage. It also applies to HHS’s own health programs.




Is Section 1557 currently being enforced?


Section 1557 has been in effect since the enactment of the ACA in 2010. Since that time, the Office for Civil Rights (OCR) has been receiving and investigating discrimination complaints under Section 1557.




What is the effective date for the final rule?


The final rule is effective 60 days after publication in the Federal Register. There are three situations in which covered entities have additional time to comply with the rule’s requirements: posting notices of consumer rights and taglines; accessibility standards for buildings not previously covered by the Americans with Disabilities Act; and design changes to health coverage.




Why is OCR issuing a final rule addressing Section 1557?


OCR is issuing this final rule to educate consumers about their rights and to help covered entities understand their legal obligations under Section 1557. The final rule builds on the standards of the four Federal civil rights laws referenced in Section 1557 and their implementing regulations: Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Age Discrimination Act of 1975. Among other things, the final rule implements prohibitions against sex discrimination in federally funded health care programs and establishes standards that apply to the Health Insurance Marketplaces and health programs administered by HHS.




Section 1557 of the ACA require each covered entity to “post taglines in at least the top 15 languages spoken by individuals with LEP within the relevant State or States.” 45 C.F.R. § 92.8(d)(1). What are these languages in each State?


As a resource for covered entities, OCR has made available a table displaying OCR’s list of the top 15 languages spoken by individuals with limited English proficiency (LEP) in each State, the District of Columbia, Puerto Rico and each U.S. Territory. OCR created this list for covered entities’ use in identifying languages in which to provide translated taglines in implementing §92.8(d)(1)-(2). OCR’s list is organized first by State with the U.S. Territories at the end of the table and then by language. Languages estimated to be spoken by the most individuals with LEP are ranked as number 1 Covered entities may use the information in this list to implement §92.8(d)(1)-(2), although nothing in the Section 1557 regulation requires covered entities to use OCR’s particular resource in doing so. In implementing §92.8(d)(1)-(2), covered entities may refer to sources other than OCR’s list if covered entities have a reasonable basis for relying on such sources when considering characteristics such as the currency, reliability, and stability of the data. Covered entities may use such sources even if the list of languages produced from those sources is different from OCR’s list or has variations in the relative rank of the languages. As a reminder, nothing in the Section 1557 regulation bars a covered entity from including taglines in languages beyond those triggered by §92.8(d)(1)-(2). For instance, a covered entity may choose to include taglines in additional languages to maximize the breadth of national origin populations informed about the availability of language assistance services. Please be aware that providing taglines as §92.8(d)(1)-(2) required does not fulfill the covered entity’s obligation for complying with the prohibition of national origin discrimination under Section 1557 and the rule. Under §92.201(a), covered entities must also take reasonable steps to provide meaningful access to each individual with LEP eligible to be served or likely to be encountered in the entity’s health programs or activities. Independent of the tagline requirement at §92.8(d)(1)-(2), covered entities are responsible for providing timely and accurate language assistance services, such as oral interpretation and written translation, in non-English languages, even if the language is not shown on OCR’s list, when doing so is a reasonable step to provide meaningful access to an individual with LEP.




What data did OCR use to compile its list of the top 15 languages spoken by individuals with LEP in each of the 50 States, the District of Columbia, and Puerto Rico?


OCR used the U.S. Census Bureau’s (Bureau) American Community Survey’s (ACS) data set entitled “Language Spoken at Home by Ability to Speak English for the Population 5 Years and Older.” The tables for this data set display, among other variables and geographic units, the estimated number of individuals, who speak non-English languages in each State,who speak English less than “very well,” which OCR used as a proxy for the population with LEP OCR used the most recent State-based data set available to OCR during the development of the Section 1557 rule – the 2014 ACS 5-year estimates, available as one of the Bureau’s American FactFinder tables.[i]The American FactFinder tables include estimates on a total of 39 individual languages and language groups. The language groups on the American FactFinder tables “bundle” more than one language in the groups’ estimates. For instance, the American FactFinder tables estimate the prevalence of individuals who speak English less than “very well” who speak “Other Indic languages,” “Other Pacific Island Languages,” “African Languages,” and “Other and unspecified languages,” among other groups. For these groups where more detail was needed to identify the languages represented, OCR used the detailed State-based data set from the 2013 ACS 5-year estimates – which were the most recent estimates available during the development of the Section 1557 rule.[ii] The detailed tables display approximately 380 languages and language groups. On OCR’s list, an asterisk after the language denotes that the estimate came from the Bureau’s detailed 2013 ACS 5-year estimates rather than from the 2014 ACS 5-year estimates.




Why did OCR rely on the ACS 5-year estimates rather than the 1-year estimates?


OCR used the 5-year estimates (which average five years of data) rather than the 1-year estimates (which represent one year of data). This choice best balanced the currency of the estimates with their reliability and stability. In analyzing small populations, such as some LEP populations, a data source that averages five years of data is more reliable and stable than a source that includes only one year of data.[iii]




What data did OCR use to compile its estimates of the top languages spoken by individuals with LEP for each of the U.S. Territories, other than Puerto Rico?


For the U.S. Territories other than Puerto Rico, OCR used the data available from the U.S. Census Bureau, 2010 Census of Population and Housing.[iv] OCR used this data source instead of the ACS because the ACS does not include data on the U.S. Territories, other than Puerto Rico.
The language data available from the 2010 Census of Population and Housing for the U.S. Territories do not allow for a one-to-one comparison to the data available from the Bureau’s ACS for the 50 States, the District of Columbia, and Puerto Rico. In contrast to the Bureau’s ACS data estimating the number of individuals who speak non-English languages who speak English less than “very well,” the data available for Guam, the Commonwealth of Northern Mariana Islands, and American Samoa show the number of individuals who speak a non-English language. These estimates do not indicate how many individuals who speak a non-English language also speak English and whether that English-speaking ability is limited. The language estimates available for the U.S. Virgin Islands show individuals who speak a non-English language who speak English “not well.” These estimates do not indicate how many individuals speak a particular non-English language who also speak English less than “very well.”




Did OCR make any technical adjustments to the data? For example, how did OCR address the fact that even the detailed 2013 ACS 5-year estimates by State contain information on language groups, as opposed to individual languages?


In compiling its list for covered entities’ use in implementing § 92.8(d)(1)-(2), OCR made two main types of technical adjustments to the data OCR used. First, OCR omitted languages from the detailed language tables that still represented a language group rather than a single language or list of single languages for which covered entities could identify a specific language in which to provide a translated tagline in implementing §92.8(d)(1)-(2). This technical adjustment resulted in the omission of language groups, such as “African” and “Mayan language,” from OCR’s list. Second, OCR omitted any spoken languages that do not have a written equivalent in which a translated tagline could be provided. This technical adjustment resulted in the omission of specific languages, such as Crow, Dakota, and Inupik, from OCR’s list. These technical adjustments made by OCR are limited to the provision of this particular resource. Consequently, the omission from this specific resource of language groups such as “African” and “Mayan language” does not relieve a covered entity from the separate obligation to take reasonable steps to provide meaningful access to an individual with LEP whose primary language for communication is a specific African or Mayan language. Similarly, the omission from this specific resource of spoken languages that do not have a written equivalent does not relieve a covered entity from the separate obligation to take reasonable steps to provide meaningful access to an individual with LEP whose primary language for communication is a spoken language that does not have a written equivalent.




Why do some of the States on OCR’s list have more than 15 languages listed?


Four States (Colorado, Maryland, Rhode Island, and Virginia) and the District of Columbia have 17 languages listed because the detailed 2013 ACS language tables identify an estimate of language speakers for a grouping of three languages – Kru, Ibo, and Yoruba. The detailed ACS language estimates do not further disaggregate the number of individuals speaking English less than “very well” who speak Kru, Ibo, and Yoruba, respectively. Although all three languages are grouped as one entry on the detailed 2013 ACS 5-year language tables with one combined estimate of language speakers, OCR counted each of these three languages separately because they are distinct languages. As a result, these four States and the District of Columbia have 15 estimates displayed but more than 15 languages listed. OCR recommends that covered entities that rely on OCR’s list in implementing § 92.8(d)(1)-(2) and that serve individuals in these States or the District of Columbia post taglines in 17 languages. This recommendation is informed by the purpose underlying the ACA to expand access to health care, reduce barriers, and address health disparities.




In OCR’s list, why are there significantly fewer than 15 languages listed for each of the U.S. Territories other than Puerto Rico? For instance, only one language is listed for Guam.


OCR has listed fewer than 15 languages for the U.S. Territories other than Puerto Rico because the data OCR used to estimate the languages spoken by individuals with LEP in the U.S. Territories other than Puerto Rico identify a mere handful of languages or language groups.
Using Guam as an example, the table of estimates for “Language Spoken at Home, Frequency of English Usage, and Sex by Ethnic Origin or Race” from the 2010 Census of Population and Housing provides data on the number of individuals in Guam who speak one language (Chamorro) and the four language groups: “Philippine languages,” “Other Pacific Island languages,” “Asian languages,” and “Other languages.”[v] Because the language groups listed are not further disaggregated to identify the specific languages into which a tagline or other materials could be translated, OCR made technical adjustments to omit the aggregated language groups. Consequently, the only individual language estimated to be spoken by individuals with LEP in Guam that OCR could identify for inclusion in this specific resource is Chamorro. Covered entities operating health programs or activities that serve individuals in the U.S. Territories may be in a better position to identify specific languages spoken by individuals with LEP in which to provide translated taglines to meet their obligations under §92.8(d)(1)-(2). The technical adjustments made by OCR are limited to the provision of this particular resource. Consequently, the omission from this specific resource of language groups, such as “Philippine languages,” “Other Pacific Islands languages,” and “Asian languages” for Guam, does not relieve a covered entity that serves individuals in Guam through a health program or activity from the separate obligation under §92.201(a) to take reasonable steps to provide meaningful access to an individual with LEP whose primary language for communication is not shown on OCR’s list




Some languages listed in the table that OCR has made available have more than one spoken or written dialect, which means that the grammar, vocabulary, pronunciation, or usage may differ for the same language. For these languages, into which dialects did OCR translate its sample taglines and other materials?


For the following languages with more than one dialect, OCR translated its sample taglines and other materials into the dialects as follows: - For Spanish, materials are translated into neutral Spanish for the United States. - For Chinese, materials are translated into traditional Chinese. - For French Creole, materials are translated into Haitian Creole. - For French, materials are translated into the European dialect. - For Portuguese, materials are translated into the European dialect. - For Persian, materials are translated into Farsi. - For Cushite, materials are translated into Oromo. - For Serbo-Croatian, materials are translated into Serbian. - For Syriac, materials are translated into Assyria. - For Kru, materials are translated into Bassa. - For Micronesian, materials are translated into Pohnpeian. - For Bantu, materials are translated into Kirundi. - For Sudanic, materials are translated into Fulfulde. - For Nilotic, materials are translated into Dinka.




The population with LEP may change in future years, affecting the languages spoken by individuals with LEP that are ranked within the top 15. Will OCR update its list of the top 15 languages in the future based on newer data? If so, will OCR release the sample tagline, sample notice of nondiscrimination, and sample nondiscrimination statement in languages not captured within the 64 languages in which OCR has already made such translated materials available?


The Section 1557 rule does not specify when to revisit the languages triggered by the standard in §92.8(d)(1)-(2). As newer data from the Bureau's American Community Survey becomes available for the dataset entitled “Language Spoken at Home by Ability to Speak English for the Population 5 Years and Older,” OCR will determine if and when the standard in §92.8(d)(1)-(2) triggers languages in addition to the 64 already triggered by this standard. When additional languages are warranted, OCR will make available the sample tagline, nondiscrimination notice, and nondiscrimination statement in the additional non-English languages





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