sign language interpreters
• Written information in other formats (large print, audio, accessible electronic formats)
• Provides free language services to people whose primary language is not English, such as:
• Qualified interpreters
• Information written in other languages
If you need these services, contact [Name of civil rights coordinator].
If you believe that [Name of covered entity] has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
[name of civil rights coordinator]
[mailing address]
[telephone number]
[TTY number—if covered entity has one]
[fax]
[email]
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, [name of civil rights coordinator] is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue SW.
Room 509F, HHH Building
Washington, DC 20201
Toll Free: 1.800.368.1019; 800.537.7697 (TDD).
Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.
Source: HHS Office for Civil Rights
Sample Notice of Nondiscrimination for Offices with Fewer than 15 Employees
Covered entities with fewer than 15 employees are not required to have a written grievance procedure, so their Notice of Nondiscrimination does not need to include information about filing a grievance with the covered entity. The following Notice of Nondiscrimination, which is also in Appendix B of this publication, is based on the OCR sample Notice of Nondiscrimination, but omits the information about the grievance procedure:
Sample Notice of Nondiscrimination for Offices with Fewer than 15 Employees
Discrimination is Against the Law
[Name of covered entity] complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. [Name of covered entity] does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
[Name of covered entity]:
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
• Qualified sign language interpreters
• Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
• Qualified interpreters
• Information written in other languages
If you need these services, contact [Name of appropriate dental office staff member].
If you believe that [Name of covered entity] has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
Toll free: 1.800.368.1019; 800.537.7697 (TDD)
Complaint forms are available at www.hhs.gov/ocr/office/file/index.html.
Adapted from: HHS Office for Civil Rights
Taglines
Taglines are short statements in the top 15 non-English languages in your state, telling the public that language assistance services are available free of charge. A covered dentist or dental practice may use the ADA sample tagline, the OCR sample tagline, or may develop its own tagline and have it translated, as long as the tagline meets the requirements of the final rule.
• ADA Sample Tagline. The ADA has developed a sample tagline that is targeted to dentistry. State-by-state lists of this tagline translated into each state’s or US territory’s top 15 languages. ADA members may access this information at https://success.ada.org/en/regulatory-legal/section-1557/~/link.aspx?_id=6FA08470962D4A66BEBAA86451248E3B&_z=z.
The ADA sample tagline reads:
We will take reasonable steps to provide free-of-charge language assistance services to people who speak languages we are likely to hear in our practice and who don’t speak English well enough to talk to us about the dental care we are providing.
• OCR Sample Tagline. The OCR has also developed a sample tagline, available in Appendix D of this document:
• ATTENTION: If you speak [insert language], language assistance services, free of charge, are available to you. Call 1-xxx-xxx-xxxx (TTY: g1-xxx-xxx-xxxx).
To find the top 15 non-English languages in your state, visit the OCR website at www.hhs.gov/sites/default/files/resources-for-covered-entities-top-15-languages-list.pdf?language=es.
The OCR also provides translations of the OCR sample tagline into various languages on its website at www.hhs.gov/civil-rights/for-individuals/section-1557/translated-resources/index.html?language=es.
You must post the notices in your office, on your website (if you have one), and in significant publications and communications targeted to patients or the public.
• Office. The notices must be placed in locations where you interact with the public, and must be in a conspicuously-visible font size.
• Website. On your website, they must be in a conspicuous location accessible from the home page.
• Publications and Communications. The notices must be printed in significant publications and/or communications targeted to patients and to the public. This may include patient handbooks, outreach publications, or written notices pertaining to rights or benefits or requiring a response from an individual, as well as significant communications (such as letters) to an individual.
There is no clear test to determine what is considered a “significant” publication or communication.
OCR intends to interpret “significant communications and publications” broadly and believes you are in the best position to determine which communications and publications are significant.OCR has suggested that factors may include the importance of the program,