[Federal Register Volume 68, Number 153 (Friday, August 8, 2003)]
[Notices]
[Pages 47311-47323]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-20179]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Guidance to Federal Financial Assistance Recipients Regarding 
Title VI Prohibition Against National Origin Discrimination Affecting 
Limited English Proficient Persons

AGENCY: Health and Human Services, HHS.

ACTION: Policy guidance document.

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SUMMARY: The Department of Health and Human Services (HHS) publishes 
revised Guidance to Federal Financial Assistance Recipients Regarding 
Title VI Prohibition Against National Origin Discrimination Affecting 
Limited English Proficient Persons (``Revised HHS LEP Guidance''). This 
revised HHS LEP Guidance is issued pursuant to Executive Order 13166. 
HHS is seeking comment on the revised HHS LEP Guidance for a 120-day 
period ending on January 6, 2004.

DATES: This Guidance is effective immediately. Comments must be 
submitted on or before January 6, 2004. HHS will review all comments 
and will determine if modifications to the Guidance are necessary. This 
Guidance supplants existing guidance on the same subject originally 
published at 65 FR 52762 (August 30, 2000).

ADDRESSES: Comments should be addressed to Deeana Jang with 
``Attention: LEP Comments,'' and should be sent to 200 Independence 
Avenue, SW, Room 506F, Washington, DC 20201. Comments may also be 
submitted by e-mail at LEP.comments@hhs.gov.

FOR FURTHER INFORMATION CONTACT: Onelio Lopez at the Office for Civil 
Rights, U.S. Department of Health and Human Services, 200 Independence 
Avenue, SW, Room 506F, Washington, DC 20201, addressed with 
``Attention: LEP Comments;'' telephone 202-205-0192; TDD: toll-free 1-
800-537-7697. Arrangements to receive the policy in an alternative 
format may be made by contacting the named individual.

SUPPLEMENTARY INFORMATION: The United States Department of Health and 
Human Services (HHS) is publishing revised ``Guidance to Federal 
Financial Assistance Recipients Regarding Title VI Prohibition Against 
National Origin Discrimination Affecting Limited English Proficient 
Persons'' (``Revised HHS LEP Guidance''). This guidance was originally 
published on August 30, 2000, and included a 60-day comment period. See 
65 FR 52762. This original guidance was republished for additional 
comment on February 1, 2002, pursuant to a memorandum issued by the 
United States Department of Justice on October 26, 2001. See 67 FR 
4968.
    On March 14, 2002, the Office of Management and Budget (OMB) issued 
a Report to Congress entitled ``Assessment of the Total Benefits and 
Costs of Implementing Executive Order No. 13166: Improving Access to 
Services for Persons with Limited English Proficiency.'' Among other 
things, the Report recommended the adoption of uniform guidance across 
all federal agencies, with flexibility to permit tailoring to each 
agency's specific recipients. Consistent with this OMB recommendation, 
DOJ published LEP Guidance for DOJ recipients, which was drafted and 
organized to also function as a model for similar guidance documents by 
other Federal grant-making agencies. See 67 FR 41455 (June 18, 2002).
    This revised HHS LEP Guidance reflects consideration of the 
comments received and the subsequent guidance of DOJ. HHS welcomes 
comments from the public on the revised guidance document, and has 
announced the extended comment period to encourage comment from the 
public and from recipients regarding experience in applying this 
revised guidance. Following the comment period, HHS will evaluate 
whether further revisions to the guidance are necessary or appropriate.
    The text of the guidance appears below. Appendix A to the guidance 
is a series of questions and answers that provides a useful summary of 
a number of the major aspects of the guidance.
    It has been determined that this revised HHS LEP Guidance does not 
constitute a regulation subject to the rulemaking requirements of the 
Administrative Procedure Act, 5 U.S.C. 553, and is not subject to 
Executive Order 12866 (Regulatory Review and Planning, September 30, 
1993).

    Dated: August 4, 2003.
Richard M. Campanelli,
Director, Office for Civil Rights.

I. Background and Legal History

    Section 601 of Title VI of the Civil Rights Act of 1964, 42 U.S.C. 
2000d, provides that no person shall ``on the ground of race, color, or 
national origin, be excluded from participation in, be

[[Page 47312]]

denied the benefits of, or be subjected to discrimination under any 
program or activity receiving Federal financial assistance.'' Section 
602 authorizes and directs federal agencies that are empowered to 
extend federal financial assistance to any program or activity ``to 
effectuate the provisions of [section 601] * * * by issuing rules, 
regulations, or orders of general applicability.'' 42 U.S.C. 2000d-1.
    Department of Health and Human Services regulations promulgated 
pursuant to section 602 forbid recipients from ``utiliz[ing] criteria 
or methods of administration which have the effect of subjecting 
individuals to discrimination because of their race, color, or national 
origin, or have the effect of defeating or substantially impairing 
accomplishment of the objectives of the program with respect to 
individuals of a particular race, color, or national origin.'' 45 CFR 
80.3(b)(2).
    The Supreme Court, in Lau v. Nichols, 414 U.S. 563 (1974), 
interpreted regulations promulgated by the former Department of Health, 
Education, and Welfare (HHS's predecessor), 45 CFR 80.3(b)(2), to hold 
that Title VI prohibits conduct that has a disproportionate effect on 
LEP persons because such conduct constitutes national-origin 
discrimination. In Lau, a San Francisco school district that had a 
significant number of non-English speaking students of Chinese origin 
was required to take reasonable steps to provide them with a meaningful 
opportunity to participate in federally funded educational programs.
    On August 11, 2000, Executive Order 13166 was issued. ``Improving 
Access to Services for Persons with Limited English Proficiency,'' 65 
FR 50121 (August 16, 2000). Under that order, every federal agency that 
provides financial assistance to non-federal entities must publish 
guidance on how their recipients can provide meaningful access to LEP 
persons and thus comply with Title VI regulations forbidding funding 
recipients from ``restrict[ing] an individual in any way in the 
enjoyment of any advantage or privilege enjoyed by others receiving any 
service, financial aid, or other benefit under the program'' or from 
``utiliz[ing] criteria or methods of administration which have the 
effect of subjecting individuals to discrimination because of their 
race, color, or national origin, or have the effect of defeating or 
substantially impairing accomplishment of the objectives of the program 
as respects individuals of a particular race, color, or national 
origin.''
    On that same day, the Department of Justice (``DOJ'') issued a 
general guidance document addressed to ``Executive Agency Civil Rights 
Officers'' setting forth general principles for agencies to apply in 
developing guidance documents for recipients pursuant to the Executive 
Order. ``Enforcement of Title VI of the Civil Rights Act of 1964 
National Origin Discrimination Against Persons With Limited English 
Proficiency,'' 65 FR 50123 (August 16, 2000) (``DOJ LEP Federal 
Guidance'').
    Subsequently, federal agencies raised questions regarding the 
requirements of the Executive Order, especially in light of the Supreme 
Court's decision in Alexander v. Sandoval, 532 U.S. 275 (2001). On 
October 26, 2001, Ralph F. Boyd, Jr., Assistant Attorney General for 
the Civil Rights Division, issued a memorandum for ``Heads of 
Departments and Agencies, General Counsels and Civil Rights 
Directors.'' This memorandum clarified and reaffirmed the DOJ LEP 
guidance for recipients of DOJ federal financial assistance in light of 
Sandoval.\1\ The Assistant Attorney General stated that because 
Sandoval did not invalidate any Title VI regulations that proscribe 
conduct that has a disparate impact on covered groups--the types of 
regulations that form the legal basis for the part of Executive Order 
13166 that applies to federally assisted programs and activities--the 
Executive Order remains in force.
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    \1\ The memorandum noted that some commentators had interpreted 
Sandoval as impliedly striking down the disparate-impact regulations 
promulgated under Title VI that form the basis for the part of 
Executive Order 13166 that applies to federally assisted programs 
and activities. See, e.g., Sandoval, 532 U.S. at 286, 286 n.6 
(``[W]e assume for purposes of this decision that section 602 
confers the authority to promulgate disparate-impact regulations; . 
. . We cannot help observing, however, how strange it is to say that 
disparate-impact regulations are `inspired by, at the service of, 
and inseparably intertwined with Sec. 601 * * * when Sec. 601 
permits the very behavior that the regulations forbid.''). The 
memorandum, however, made clear that DOJ disagreed with the 
commentators' interpretation. DOJ stated that Sandoval holds 
principally that there is no private right of action to enforce 
Title VI disparate-impact regulations. It did not address the 
validity of those regulations or Executive Order 13166, or otherwise 
limit the authority and responsibility of federal grant agencies to 
enforce their own implementing regulations.
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    Consistent with Executive Order 13166, HHS developed its own 
guidance document for recipients and initially issued it on August 30, 
2000. ``Title VI of the Civil Rights Act of 1964; Policy Guidance on 
the Prohibition Against National Origin Discrimination As It Affects 
Persons With Limited English Proficiency,'' 65 FR 52762 (August 30, 
2000) (``HHS Guidance''). Following the instructions in the October 26, 
2001 memorandum from Ralph F. Boyd, Jr., the Department republished, on 
February 1, 2002, its existing guidance document for additional public 
comment. ``Office for Civil Rights; Title VI of the Civil Rights Act of 
1964; Policy Guidance on the Prohibition Against National Origin 
Discrimination As It Affects Persons With Limited English 
Proficiency,'' 67 FR 4968 (February 1, 2002).

II. Revised HHS LEP Guidance

    Following republication of our guidance in February 2002, the 
Department received nearly 200 public comments. Most comments were in 
full support of the principles behind the HHS Guidance, and a number 
supported maintaining the guidance without change. While the comments 
reflected recognition that effective communication is critical for 
necessary health and human services, many commentors raised serious 
concerns about coverage, compliance costs, and use of family and 
friends as interpreters. In addition, many providers of services 
requested assistance from the Office for Civil Rights on how to comply 
with both general and specific provisions of the guidance.
    On July 8, 2002, Assistant Attorney General Boyd issued a 
memorandum expressing the need for consistency across federal agency 
LEP guidance documents. Specifically, he requested that the Department 
(and all other affected agencies) use the DOJ LEP guidance (published 
at 67 FR 41455, June 18, 2002) as a model, and revise and republish the 
HHS guidance based on that model for public comment.
    The DOJ's role under Executive Order 13166 is unique. The Executive 
Order charges DOJ with responsibility for providing LEP Guidance to 
other Federal agencies and for ensuring consistency among each agency-
specific guidance. DOJ's guidance stated the following principles. 
``Consistency among Departments of the federal government is 
particularly important. Inconsistency or contradictory guidance could 
confuse recipients of federal funds and needlessly increase costs 
without rendering the meaningful access for LEP persons that this 
Guidance is designed to address. As with most government initiatives, 
this requires balancing several principles. While this Guidance 
discusses that balance in some detail, it is important to note the 
basic principles behind that balance. First, we must ensure that 
federally assisted programs aimed at the American public do not leave 
some behind simply because they face challenges communicating in 
English.

[[Page 47313]]

This is of particular importance because, in many cases, LEP 
individuals form a substantial portion of those encountered in 
federally assisted programs. Second, we must achieve this goal while 
finding constructive methods to reduce the costs of LEP requirements on 
small businesses, small local governments, or small non-profits that 
receive federal financial assistance.''
    HHS believes that the DOJ model guidance responds to the important 
issues raised in comments on the HHS document published in February, 
and the Department is confident that the DOJ LEP Guidance serves as an 
appropriate model for HHS to adopt. The Department notes that it has 
made certain modifications for purposes of clarity and organization, 
and a few additional modifications to accommodate particular 
programmatic needs and purposes.
    There are many productive steps that the federal government, either 
collectively or as individual agencies, can take to help recipients 
reduce the costs of language services without sacrificing meaningful 
access for LEP persons. Without these steps, certain smaller recipients 
of Federal financial assistance may well choose not to participate in 
federally assisted programs, threatening the critical functions that 
the programs strive to provide. To that end, the Department plans to 
continue to provide assistance and guidance in this important area. In 
addition, HHS plans to work with representatives of state health and 
social service agencies, hospital associations, medical and dental 
associations, managed care organizations, and LEP persons to identify 
and share model plans, examples of best practices, and cost-saving 
approaches. Moreover, HHS intends to explore how language assistance 
measures, resources and cost-containment approaches developed with 
respect to its own federally conducted programs and activities can be 
effectively shared or otherwise made available to recipients, 
particularly small businesses, small local governments, and small non-
profits. An interagency working group on LEP has developed a Web site, 
http://www.lep.gov, to assist in disseminating this information to 
recipients, federal agencies, and the communities being served.
    As discussed earlier, in certain circumstances, the failure to 
ensure that LEP persons can effectively participate in, or benefit 
from, federally-assisted programs and activities may violate the 
prohibition under Title VI of the Civil Rights Act of 1964, 42 U.S.C. 
2000d, and the Title VI regulations against national origin 
discrimination. Specifically, the failure of a recipient of Federal 
financial assistance from HHS to take reasonable steps to provide LEP 
persons with meaningful opportunity to participate in HHS-funded 
programs may constitute a violation of Title VI and HHS's implementing 
regulations. The purpose of this policy guidance is to assist 
recipients in fulfilling their responsibilities to provide meaningful 
access to LEP persons under existing law. This policy guidance 
clarifies existing legal requirements for LEP persons by providing a 
description of the factors recipients should consider in fulfilling 
their responsibilities to LEP persons.\2\ These are the same criteria 
HHS will use in evaluating whether recipients are in compliance with 
Title VI and the Title VI regulations.
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    \2\ The policy guidance is not a regulation but rather a guide. 
Title VI and its implementing regulations require that recipients 
take reasonable steps to ensure meaningful access by LEP persons. 
This guidance provides an analytical framework that recipients may 
use to determine how best to comply with statutory and regulatory 
obligations to provide meaningful access to the benefits, services, 
information, and other important portions of their programs and 
activities for individuals who are limited English proficient.
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III. Who Is Covered?

    Department of Health and Human Services regulations, 45 CFR 
80.3(b)(2), require all recipients of federal financial assistance from 
HHS to provide meaningful access to LEP persons.\3\ Federal financial 
assistance includes grants, training, use of equipment, donations of 
surplus property, and other assistance.
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    \3\ Pursuant to Executive Order 13166, the meaningful access 
requirement of the Title VI regulations and the four-factor analysis 
set forth in the DOJ LEP Guidance are to apply additionally to the 
programs and activities of federal agencies, including HHS.
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    Recipients of HHS assistance may include, for example:
    [sbull] Hospitals, nursing homes, home health agencies, and managed 
care organizations.
    [sbull] Universities and other entities with health or social 
service research programs.
    [sbull] State, county, and local health agencies.
    [sbull] State Medicaid agencies.
    [sbull] State, county and local welfare agencies.
    [sbull] Programs for families, youth, and children.
    [sbull] Head Start programs.
    [sbull] Public and private contractors, subcontractors and vendors.
    [sbull] Physicians and other providers who receive Federal 
financial assistance from HHS.
    Recipients of HHS assistance do not include, for example, providers 
who only receive Medicare Part B payments.\4\
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    \4\ HHS's Title VI regulations do not apply to (i) Any federal 
financial assistance by way of insurance or guaranty contracts, (ii) 
the use of any assistance by any individual who is the ultimate 
beneficiary under any program which receives federal financial 
assistance, and (iii) any employment practice, under any such 
program, or any employer, employment agency, or labor organization, 
except as otherwise described in the Title VI regulations. 45 CFR 
80.2.
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    Subrecipients likewise are covered when federal funds are passed 
through from one recipient to a subrecipient.
    Coverage extends to a recipient's entire program or activity, i.e., 
to all parts of a recipient's operations. This is true even if only one 
part of the recipient receives the federal assistance.\5\
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    \5\ However, if a federal agency were to decide to terminate 
federal funds based on noncompliance with Title VI or its 
implementing regulations, only funds directed to the particular 
program or activity that is out of compliance could be terminated. 
42 U.S.C. 2000d-1.
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    Example: HHS provides assistance to a state department of health to 
provide immunizations for children. All of the operations of the entire 
state department of health--not just the particular immunization 
programs--are covered.
    Finally, some recipients operate in jurisdictions in which English 
has been declared the official language. Nonetheless, these recipients 
continue to be subject to federal non-discrimination requirements, 
including those applicable to the provision of federally assisted 
services to persons with limited English proficiency.

IV. Who Is a Limited English Proficient Individual?

    Individuals who do not speak English as their primary language and 
who have a limited ability to read, write, speak, or understand English 
may be limited English proficient, or ``LEP,'' and may be eligible to 
receive language assistance with respect to a particular type of 
service, benefit, or encounter.
    Examples of populations likely to include LEP persons who are 
encountered and/or served by HHS recipients and should be considered 
when planning language services may include such as those:
    [sbull] Persons seeking Temporary Assistance for Needy Families 
(TANF), and other social services.
    [sbull] Persons seeking health and health-related services.
    [sbull] Community members seeking to participate in health 
promotion or awareness activities.
    [sbull] Persons who encounter the public health system.

[[Page 47314]]

    [sbull] Parents and legal guardians of minors eligible for coverage 
concerning such programs.

V. How Does a Recipient Determine the Extent of Its Obligation To 
Provide LEP Services?

    Recipients 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 and costs. As 
indicated above, the intent of this guidance is to suggest a balance 
that ensures meaningful access by LEP persons to critical services 
while not imposing undue burdens on small business, small local 
governments, or small nonprofits.
    After applying the above four-factor analysis, a recipient may 
conclude that different language assistance measures are sufficient for 
the different types of programs or activities in which it engages, or, 
in fact, that, in certain circumstances, recipient-provided language 
services are not necessary. (As discussed below, recipients may want to 
consider documenting their application of the four-factor test to the 
services they provide.) For instance, some of a recipient's activities 
will be more important than others and/or have greater impact on or 
contact with LEP persons, and thus may require more in the way of 
language assistance. The flexibility that recipients have in addressing 
the needs of the LEP populations they serve does not diminish, and 
should not be used to minimize, the obligation that those needs be 
addressed. HHS recipients should apply the following four factors to 
the various kinds of contacts that they have with the public to assess 
language needs and decide what reasonable steps, if any, they should 
take to ensure meaningful access for LEP persons.

(1) The Number or Proportion of LEP Persons Served or Encountered in 
the Eligible Service Population

    One factor in determining what language services recipients should 
provide is the number or proportion of LEP persons from a particular 
language group served or encountered in the eligible service 
population. The greater the number or proportion of these LEP persons, 
the more likely language services are needed. Ordinarily, persons 
``eligible to be served, or likely to be directly affected, by'' a 
recipient's program or activity are those who are served or encountered 
in the eligible service population. This population will be program-
specific, and includes persons who are in the geographic area that has 
been approved by a federal grant agency as the recipient's service 
area. However, where, for instance, a particular office of the county 
or city health department serves a large LEP population, the 
appropriate service area is most likely that office, and not the entire 
population served by the department. Where no service area has 
previously been approved, the relevant service area may be that which 
is approved by state or local authorities or designated by the 
recipient itself, provided that these designations do not themselves 
discriminatorily exclude certain populations. When considering the 
number or proportion of LEP individuals in a service area, recipients 
should consider whether the minor children their programs serve have 
LEP parent(s) or guardian(s) with whom the recipient may need to 
interact.
    Recipients should first examine their prior experiences with LEP 
encounters and determine the breadth and scope of language services 
that were needed. In certain circumstances, it is important in 
conducting this analysis to include language minority populations that 
are eligible for their programs or activities but may be underserved 
because of existing language barriers. Other data should be consulted 
when appropriate to refine or validate a recipient's prior experience, 
including the latest census data for the area served, data from school 
systems and from community organizations, and data from state and local 
governments.\6\ Community agencies, school systems, religious 
organizations, legal aid entities, and others can often assist in 
identifying populations which may be underserved because of existing 
language barriers and who would benefit from the recipient's program, 
activity, or service, were language services provided.
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    \6\ The focus of the analysis is on lack of English proficiency, 
not the ability to speak more than one language. Note that 
demographic data may indicate the most frequently spoken languages 
other than English and the percentage of people who speak that 
language who speak or understand English less than well. Some of the 
most commonly spoken languages other than English may be spoken by 
people who are also overwhelmingly proficient in English. Thus, they 
may not be the languages spoken most frequently by limited English 
proficient individuals. When using demographic data, it is important 
to focus in on the languages spoken by those who are not proficient 
in English.
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(2) The Frequency With Which LEP Individuals Come in Contact With the 
Recipient's Program, Activity or Service

    Recipients should assess, as accurately as possible, the frequency 
with which they have or should have contact with an LEP individual from 
different language groups seeking assistance. The more frequent the 
contact with a particular language group, the more likely that enhanced 
language services in that language are needed. The steps that are 
reasonable for a recipient that serves an LEP person on a one-time 
basis will be very different than those expected from a recipient that 
serves LEP persons daily. It is also advisable to consider the 
frequency of different types of language contacts. For example, 
frequent contacts with Spanish-speaking people who are LEP may require 
certain assistance in Spanish. Less frequent contact with different 
language groups may suggest a different and less intensified solution. 
If an LEP individual accesses a recipient's program, activity, or 
service on a daily basis, a recipient has greater duties than if an LEP 
individual's contact with the recipient's program, activity, or service 
is unpredictable or infrequent. But even recipients that serve LEP 
persons on an unpredictable or infrequent basis should use this 
balancing analysis to determine what to do if an LEP individual seeks 
services under the program in question. This plan need not be 
intricate. It may be as simple as being prepared to use one of the 
commercially available telephonic interpretation services to obtain 
immediate interpreter services. For example, a drug treatment program 
that encounters LEP persons on a daily basis most likely may have a 
greater obligation than a drug treatment program that encounters LEP 
persons sporadically. The obligations of both programs are greater than 
that of a drug treatment program which has never encountered a LEP 
individual where the service area includes few or no LEP individuals.
    In applying this standard, certain recipients should take care to 
consider whether appropriate outreach to LEP persons could increase the 
frequency of contact with LEP language groups. For example, in areas 
where a community health center serves a large LEP population, outreach 
may be appropriate. On the other hand, for most individual physicians 
or dentists, outreach may not be necessary.

[[Page 47315]]

(3) The Nature and Importance of the Recipient's Program, Activity, or 
Service

    The more important the recipient's activity, information, service, 
or program, or the greater the possible consequences of the contact to 
the LEP individuals, the more likely language services are needed. A 
recipient needs to determine whether denial or delay of access to 
services or information could have serious or even life-threatening 
implications for the LEP individual. Thus, the recipient should 
consider the importance and urgency of its program, activity, or 
service. If the activity is both important and urgent--such as the 
communication of information concerning emergency surgery and the 
obtaining of informed consent prior to such surgery--it is more likely 
that relatively immediate language services are needed. Alternatively, 
if the activity is important, but not urgent--such as the communication 
of information about, and obtaining informed consent for, elective 
surgery where delay will not have any adverse impact on the patient's 
health, or communication of information regarding admission to the 
hospital for tests where delay would not affect the patient's health--
it is more likely that language services are needed, but that such 
services can be delayed for a reasonable period of time. Finally, if an 
activity is neither important nor urgent--such as a general public tour 
of a facility--it is more likely that language services would not be 
needed. The obligation to communicate rights to a person whose benefits 
are being terminated or to provide medical services to an LEP person 
who is ill differ, for example, from those to provide medical care for 
a healthy LEP person or to provide recreational programming.
    Decisions by a federal, state, or local entity to make an activity 
compulsory, such as job search programs in welfare to work programs, 
can serve as strong evidence of the program's importance.

(4) The Resources Available to the Recipient and Costs

    A recipient's level of resources and the costs that would be 
imposed on it may have an impact on the nature of the steps it should 
take to comply with Title VI. Smaller recipients with more limited 
budgets are not expected to provide the same level of language services 
as larger recipients with larger budgets. In addition, reasonable steps 
may cease to be ``reasonable'' where the costs imposed substantially 
exceed the benefits.
    Resource and cost issues, however, can often be reduced by 
technological advances; the sharing of language assistance materials 
and services among and between recipients, advocacy groups, and Federal 
grant agencies; and reasonable business practices. Where appropriate, 
training bilingual staff to act as interpreters and translators, 
information sharing through industry groups, telephonic and video 
conferencing interpretation services, pooling resources and 
standardizing documents to reduce translation needs, using qualified 
translators and interpreters to ensure that documents need not be 
``fixed'' later and that inaccurate interpretations do not cause delay 
or other costs, centralizing interpreter and translator services to 
achieve economies of scale, or the formalized use of qualified 
community volunteers, for example, may help reduce costs.\7\ Recipients 
should carefully explore the most cost-effective means of delivering 
competent and accurate language services before limiting services due 
to resource concerns. Large entities and those entities serving a 
significant number or proportion of LEP persons should ensure that 
their resource limitations are well-substantiated before using this 
factor as a reason to limit language assistance. Such recipients may 
find it useful to be able to articulate, through documentation or in 
some other reasonable manner, their process for determining that 
language services would be limited based on resources or costs.
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    \7\ Recipients with limited resources may find that entering 
into a bulk telephonic interpretation service contract will prove 
cost effective.
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* * * * *
    This four-factor analysis necessarily implicates the ``mix'' of LEP 
services required. Recipients have two main ways to provide language 
services: Oral interpretation either in person or via telephone 
interpretation service (hereinafter ``interpretation'') and written 
translation (hereinafter ``translation''). Oral interpretation can 
range from on-site interpreters for critical services provided to a 
high volume of LEP persons, to access through commercially-available 
telephonic interpretation services. Written translation, likewise, can 
range from translation of an entire document to translation of a short 
description of the document. In some cases, language services should be 
made available on an expedited basis while in others the LEP individual 
may be referred to another office of the recipient--or to another 
recipient--for language assistance. In certain circumstances, pursuant 
to an arrangement, where there is no discriminatory intent, the purpose 
is beneficial and will result in better access for LEP persons, it may 
be appropriate for a recipient to refer the LEP beneficiary to another 
recipient. For example, if two physicians in the same field, one with a 
Spanish-speaking assistant and one with a Vietnamese-speaking 
assistant, practice in the same geographic area and have a custom/
practice of referring patients between each other, it may be 
appropriate for the first doctor to refer LEP Vietnamese patients to 
the second doctor and for the second doctor to refer LEP Spanish 
patients to the first doctor. In certain circumstances, a referral 
would not be appropriate: for example, a Korean speaking LEP woman 
comes to a battered women's shelter requesting assistance. Although the 
shelter has space, it has no arrangement to provide language assistance 
for LEP persons. Instead, as with all LEP persons, the staff only offer 
her a prepared list of three shelters in the neighborhood that 
generally provide language assistance. The staff does not check to 
assure that any of the three alternative shelters can actually provide 
the Korean language assistance she needs, or that any have space 
available for her.
    The correct mix should be based on what is both necessary and 
reasonable in light of the four-factor analysis. In some circumstances, 
where the importance and nature of the activity, the number or 
proportion and frequency of contact with LEP persons may be high and 
the relative costs and resources needed to provide language services 
may be low, it may be appropriate for a recipient to hire bilingual 
staff or staff interpreters. In contrast, there may be circumstances 
where the importance and nature of the activity and number or 
proportion and frequency of contact with LEP persons may be low and the 
costs and resources needed to provide language services may be high, in 
which case language services for the particular activity may not be 
necessary. In situations that fall in between the two, it may be 
appropriate for recipients to use contract interpreters or telephone 
language lines to provide language services to LEP persons in contact 
with their program or activity. A hospital emergency room in a city 
with a significant Hmong population may need immediately available oral 
interpreters and may want to give serious consideration to hiring some 
bilingual staff. (Of course, many hospitals have already made such 
arrangements.) On the other hand, a physician's practice which 
encounters one LEP Hmong patient per month on a walk-in basis

[[Page 47316]]

may want to use a telephone interpreter service. In contrast, a dentist 
in an almost exclusively English-speaking neighborhood who has rarely 
encountered a patient who did not speak English and has never 
encountered a Hmong-speaking patient may not need, pursuant solely to 
Title VI, to provide language services for a LEP Hmong individual who 
comes in for a dental cleaning.

VI. Selecting Language Assistance Services

    Recipients have two main ways to provide language services: oral 
and written language services (interpretation and translation, 
respectively). Regardless of the type of language service provided, 
quality and accuracy of those services is critical to avoid serious 
consequences to the LEP person and to the recipient. Recipients have 
substantial flexibility in determining the appropriate mix.

A. Considerations Relating to Competency of Interpreters and 
Translators

    Competence of Interpreters. Recipients should be aware that 
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 not be competent to 
interpret in and out of English. Likewise, they may not be able to 
perform written translations.
    Competency to interpret, however, does not necessarily mean formal 
certification as an interpreter, although certification is helpful. 
When using interpreters, recipients should take reasonable steps, given 
the circumstances, to assess whether the interpreters:
    Demonstrate proficiency in and ability to communicate information 
accurately in both English and in the other language and identify and 
employ the appropriate mode of interpreting (e.g., consecutive, 
simultaneous, summarization, or sight translation);
    To the extent necessary for communication between the recipient or 
its staff and the LEP person, have knowledge in both languages of any 
specialized terms or concepts peculiar to the recipient's program or 
activity and of any particularized vocabulary and phraseology used by 
the LEP person; \8\
---------------------------------------------------------------------------

    \8\ Many languages have ``regionalisms,'' or differences in 
usage. For instance, a word that may be understood to mean something 
in Spanish for someone from Cuba may not be so understood by someone 
from Mexico. In addition, the interpreter should be aware when 
languages do not have an appropriate direct interpretation of 
certain terms and be able to provide the most appropriate 
interpretation. The interpreter should likely make the recipient 
aware of the issue, so that the interpreter and recipient can work 
to develop a consistent and appropriate set of descriptions of these 
terms in that language that can be used again, when appropriate.
---------------------------------------------------------------------------

    Understand and follow confidentiality and impartiality rules to the 
same extent as the recipient employee for whom they are interpreting 
and/or to the extent their position requires;
    Understand and adhere to their role as interpreters without 
deviating into other roles--such as counselor or legal advisor--where 
such deviation would be inappropriate (particularly in administrative 
hearings contexts).
    Some recipients, such as some state agencies, may have additional 
self-imposed requirements for interpreters. Where individual rights 
depend on precise, complete, and accurate interpretation or 
translations, particularly in the context of administrative 
proceedings, the use of certified interpreters is strongly 
encouraged.\9\
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    \9\ For those languages in which no formal accreditation or 
certification currently exists, certain recipients may want to 
consider a formal process for establishing the credentials of the 
interpreter, or assess whether a particular level of membership in a 
professional translation association can provide some indicator of 
professionalism.
---------------------------------------------------------------------------

    While quality and accuracy of language services is critical, the 
quality and accuracy of language services is nonetheless part of the 
appropriate mix of LEP services required. The quality and accuracy of 
language services in a hospital emergency room, for example, should be 
as high as possible, given the circumstances, while the quality and 
accuracy of language services in other circumstances need not meet the 
same exacting standards.
    Finally, when interpretation is needed and is reasonable, it should 
be provided in a timely manner. To be meaningfully effective, language 
assistance should be timely. While there is no single definition for 
``timely'' applicable to all types of interactions at all times by all 
types of recipients, one clear guide is that the language assistance 
should be provided at a time and place that avoids the effective denial 
of the service, benefit, or right at issue or the imposition of an 
undue burden on or delay in important rights, benefits, or services to 
the LEP person. When the timeliness of services is important, and delay 
would result in the effective denial of a benefit, service, or right, 
language assistance likely cannot be unduly delayed. Conversely, where 
access to or exercise of a service, benefit, or right is not 
effectively precluded by a reasonable delay, language assistance can 
likely be delayed for a reasonable period.
    For example, language assistance could likely not be delayed in a 
medical emergency, or when the time period in which an individual has 
to exercise certain rights is shortly to expire. On the other hand, 
when an LEP person is seeking a routine medical examination or seeks to 
apply for certain benefits and has an ample period of time to apply for 
those benefits, a recipient could likely delay the provision of 
language services by requesting the LEP person to schedule an 
appointment at a time during which the recipient would be able to have 
an appropriate interpreter available.
    Competence of Translators. As with oral interpreters, translators 
of written documents should be competent. Many of the same 
considerations apply. However, the skill of translating is very 
different from the skill of interpreting; a person who is a competent 
interpreter may or may not be competent to translate.
    Particularly where legal or other vital documents are being 
translated, competence can often be achieved by use of certified 
translators. As noted above, certification or accreditation may not 
always be possible or necessary. Competence can often be ensured by 
having a second, independent translator ``check'' the work of the 
primary translator. Alternatively, one translator can translate the 
document, and a second, independent translator could translate it back 
into English to check that the appropriate meaning has been conveyed. 
This is called ``back translation.''
    Translators should understand the expected reading level of the 
audience and, where appropriate, have fundamental knowledge about the 
target language group's vocabulary and phraseology. Sometimes direct 
translation of materials results in a translation that is written at a 
much more difficult level than the English language version or has no 
relevant equivalent meaning.\10\ Community

[[Page 47317]]

organizations may be able to help consider whether a document is 
written at a good level for the audience. Likewise, consistency in the 
words and phrases used to translate terms of art, legal, or other 
technical concepts helps avoid confusion by LEP individuals and may 
reduce costs.
---------------------------------------------------------------------------

    \10\ For instance, there may be languages which do not have an 
appropriate direct translation of some specialized medical terms and 
the translator should be able to provide an appropriate translation. 
The translator should likely also make the recipient aware of this. 
Recipients can then work with translators to develop a consistent 
and appropriate set of descriptions of these terms in that language 
that can be used again, when appropriate. Recipients may find it 
more effective and less costly if they try to maintain consistency 
in the words and phrases used to translate terms of art and other 
technical concepts. Creating or using already-created glossaries of 
commonly used terms may be useful for LEP persons and translators 
and cost effective for the recipient. Providing translators with 
examples of previous translations of similar material by the 
recipient, other recipients, or federal agencies may be helpful.
---------------------------------------------------------------------------

    While quality and accuracy of translation services is critical, the 
quality and accuracy of translation services is nonetheless part of the 
appropriate mix of LEP services required. For instance, to translate 
nonvital documents that have no legal or other consequence for LEP 
persons who rely on them, a recipient may use translators that are less 
skilled than the translators it uses to translate vital documents with 
legal or other information upon which reliance has important 
consequences. The permanent nature of written translations, however, 
imposes additional responsibility on the recipient to take reasonable 
steps to determine that the quality and accuracy of the translations 
permit meaningful access by LEP persons.

B. Oral Language Services (Interpretation)

    Interpretation is the act of listening to something in one language 
(source language) and orally translating it into another language 
(target language). Where interpretation is needed and is reasonable, 
recipients should consider some or all of the following options for 
providing competent interpreters in a timely manner:
    Hiring Bilingual Staff. When particular languages are encountered 
often, hiring bilingual staff offers one of the best, and often most 
economical, options. Recipients can, for example, fill public contact 
positions, such as social service eligibility workers or hospital 
emergency room receptionists/workers, with staff who are bilingual and 
competent to communicate directly with LEP persons in their language. 
If bilingual staff are also used to interpret between English speakers 
and LEP persons, or to orally interpret written documents from English 
into another language, they should be competent in the skill of 
interpreting. In addition, there may be times when the role of the 
bilingual employee may conflict with the role of an interpreter (for 
instance, a bilingual law clerk would probably not be able to perform 
effectively the role of a child support administrative hearing 
interpreter and law clerk at the same time, even if the law clerk were 
a qualified interpreter). Effective management strategies, including 
any appropriate adjustments in assignments and protocols for using 
bilingual staff, can ensure that bilingual staff are fully and 
appropriately utilized. When bilingual staff cannot meet all of the 
language service obligations of the recipient, the recipient should 
turn to other options.
    Hiring Staff Interpreters. Hiring interpreters may be most helpful 
where there is a frequent need for interpreting services in one or more 
languages. Depending on the facts, sometimes it may be necessary and 
reasonable to provide on-site interpreters to provide accurate and 
meaningful communication with an LEP person.
    Contracting for Interpreters. Contract interpreters may be a cost-
effective option when there is no regular need for a particular 
language skill. In addition to commercial and other private providers, 
many community-based organizations and mutual assistance associations 
provide interpretation services for particular languages. Contracting 
with and providing training regarding the recipient's programs and 
processes to these organizations can be a cost-effective option for 
providing language services to LEP persons from those language groups.
    Using Telephone Interpreter Lines. Telephone interpreter service 
lines often offer speedy interpreting assistance in many different 
languages. While telephone interpreters can be used in numerous 
situations, they may be particularly appropriate where the mode of 
communicating with an English proficient person would also be over the 
phone. Although telephonic interpretation services are useful in many 
situations, it is important to ensure that, when using such services, 
the interpreters used are competent to interpret any technical or legal 
terms specific to a particular program that may be important parts of 
the conversation. Nuances in language and non-verbal communication can 
often assist an interpreter and cannot be recognized over the phone. 
Video teleconferencing, if available, may sometimes help to resolve 
this issue where necessary. In addition, where documents are being 
discussed, it may be important to give telephonic interpreters adequate 
opportunity to review the document prior to the discussion and any 
logistical problems should be addressed.
    Using Community Volunteers. In addition to consideration of 
bilingual staff, staff interpreters, or contract interpreters (either 
in-person or by telephone) as options to ensure meaningful access by 
LEP persons, use of recipient-coordinated community volunteers, working 
with, for instance, community-based organizations may provide a cost-
effective supplemental language assistance strategy under appropriate 
circumstances. Because such volunteers may have other demands on their 
time, they may be more useful in providing language access for a 
recipient's less critical programs and activities where the provision 
of language services can reasonably be delayed. To the extent the 
recipient relies on community volunteers, it is often best to use 
volunteers who are trained in the information or services of the 
program and can communicate directly with LEP persons in their 
language. Just as with all interpreters, community volunteers used to 
interpret between English speakers and LEP persons, or to orally 
translate documents, should be competent in the skill of interpreting 
and knowledgeable about applicable confidentiality and impartiality 
rules. Recipients should consider formal arrangements with community-
based organizations that provide volunteers to address these concerns 
and to help ensure that services are available more regularly.
    Use of Family Members or Friends as Interpreters. Some LEP persons 
may feel more comfortable when a trusted family member or friend acts 
as an interpreter. However, when a recipient encounters an LEP person 
attempting to access its services, the recipient should make the LEP 
person aware that he or she has the option of having the recipient 
provide an interpreter for him/her without charge, or of using his/her 
own interpreter. Although recipients should not plan to rely on an LEP 
person's family members, friends, or other informal interpreters to 
provide meaningful access to important programs and activities, the 
recipient should, except as noted below, respect an LEP person's desire 
to use an interpreter of his or her own choosing (whether a 
professional interpreter, family member, or friend) in place of the 
free language services expressly offered by the recipient. However, a 
recipient may not require an LEP person to use a family member or 
friend as an interpreter.
    In addition, in emergency circumstances that are not reasonably 
foreseeable, a recipient may not be able to offer free language 
services, and temporary use of family members or friends as 
interpreters may be necessary.

[[Page 47318]]

However, with proper planning and implementation, recipients should be 
able to avoid most such situations.
    If the LEP person voluntarily chooses to provide his or her own 
interpreter, a recipient should consider whether making a record of 
that choice, and of the recipient's offer of assistance, is 
appropriate.
    As with the use of other non-professional interpreters, the 
recipient may need to consider issues of competence, appropriateness, 
conflicts of interest, and confidentiality in determining whether it 
should respect the desire of the LEP person to use an interpreter of 
his or her own choosing. Recipients should take reasonable steps to 
ascertain that family, legal guardians, caretakers, and other informal 
interpreters are not only competent in the circumstances, but are also 
appropriate in light of the circumstances and subject matter of the 
program, service or activity, including protection of the recipient's 
own administrative or enforcement interest in accurate interpretation.
    In some circumstances, family members (especially children) or 
friends may not be competent to provide quality and accurate 
interpretations. Issues of confidentiality, privacy, or conflict of 
interest may also arise. LEP individuals may feel uncomfortable 
revealing or describing sensitive, confidential, or potentially 
embarrassing medical, law enforcement (e.g., sexual or violent 
assaults), family, or financial information to a family member, friend, 
or member of the local community. In addition, such informal 
interpreters may have a personal connection to the LEP person or an 
undisclosed conflict of interest, such as the desire to protect 
themselves or another perpetrator in a domestic violence matter. For 
these reasons, where the LEP individual has declined the express offer 
of free language assistance and has chosen to use a family member, 
friend or other informal interpreter, if a recipient later determines 
that a family member or friend is not competent or appropriate, the 
recipient should provide competent interpreter services to the LEP 
person in place of or, if appropriate, as a supplement to the LEP 
individual's interpreter. For HHS recipient programs and activities, 
this is particularly true, for example, in administrative hearings, 
child or adult protective service investigations, situations in which 
life, 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. Where precise, 
complete, and accurate interpretations or translations of information 
and/or testimony are critical, or where the competency of the LEP 
person's interpreter is not established, a recipient may want to 
consider providing its own, independent interpreter, even if an LEP 
person wants to use his or her own interpreter as well.
    Extra caution should be exercised when the LEP person chooses to 
use a minor as the interpreter. While the LEP person's decision should 
be respected, there may be additional issues of competency, 
confidentiality, or conflict of interest when the choice involves using 
minor children as interpreters. The recipient should take reasonable 
steps to ascertain whether the LEP person's choice is voluntary, 
whether the LEP person is aware of the possible problems if the 
preferred interpreter is a minor child, and whether the LEP person 
knows that a competent interpreter could be provided by the recipient 
at no cost.
    Again, while the use of a family member or friend may be 
appropriate, if that is the choice of the LEP person, the following are 
examples of where the recipient should provide an interpreter for the 
LEP individual:
    [sbull] A woman or child is brought to an emergency room and is 
seen by an emergency room doctor. The doctor notices the patient's 
injuries and determines that they are consistent with those seen with 
victims of abuse or neglect. In such a case, use of the spouse or a 
parent to interpret for the patient may raise serious issues of 
conflict of interest and may, thus, be inappropriate.
    [sbull] A man, accompanied by his wife, visits an eye doctor for an 
eye examination. The eye doctor offers him an interpreter, but he 
requests that his wife interpret for him. The eye doctor talks to the 
wife and determines that she is competent to interpret for her husband 
during the examination. The wife interprets for her spouse as the 
examination proceeds, but the doctor discovers that the husband has 
cataracts that must be removed through surgery. The eye doctor 
determines that the wife does not understand the terms he is using to 
explain the diagnosis and, thus, that she is not competent to continue 
to interpret for her husband. The eye doctor stops the examination and 
calls an interpreter for the husband. A family member may be 
appropriate to serve as an interpreter if preferred by the LEP person 
in situations where the service provided is of a routine nature such as 
a simple eye examination. However, in a case where the nature of the 
service becomes more complex, depending on the circumstances, the 
family member or friend may not be competent to interpret.

C. Written Language Services (Translation)

    Translation is the replacement of a written text from one language 
(source language) into an equivalent written text in another language 
(target language).
    What Documents Should be Translated? After applying the four-factor 
analysis, a recipient may determine that an effective LEP plan for its 
particular program or activity includes the translation of vital 
written materials into the language of each frequently-encountered LEP 
group eligible to be served and/or likely to be affected by the 
recipient's program.
    Whether or not a document (or the information it solicits) is 
``vital'' may depend upon the importance of the program, information, 
encounter, or service involved, and the consequence to the LEP person 
if the information in question is not provided accurately or in a 
timely manner. Where appropriate, recipients are encouraged to create a 
plan for consistently determining, over time and across their various 
activities, what documents are ``vital'' to the meaningful access of 
the LEP populations they serve.
    Classifying a document as vital or non-vital is sometimes 
difficult, especially in the case of outreach materials like brochures 
or other information on rights and services. Awareness of rights or 
services is an important part of ``meaningful access.'' Lack of 
awareness that a particular program, right, or service exists may 
effectively deny LEP individuals meaningful access. Thus, where a 
recipient is engaged in community outreach activities in furtherance of 
its activities, it should regularly assess the needs of the populations 
frequently encountered or affected by the program or activity to 
determine whether certain critical outreach materials should be 
translated. In determining what outreach materials may be most useful 
to translate, such recipients may want to consider consulting with 
appropriate community organizations.
    Sometimes a document includes both vital and non-vital information. 
This may be the case when the document is very large. It may also be 
the case when the title and a phone number for obtaining more 
information on the contents of the document in frequently-encountered 
languages other than English is critical, but the document is sent out 
to the general public and cannot reasonably be translated into many 
languages. Thus, vital information may include, for instance, the 
provision

[[Page 47319]]

of information in appropriate languages other than English regarding 
where a LEP person might obtain an interpretation or translation of the 
document.
    Given the foregoing considerations, vital written materials could 
include, for example:
    [sbull] Consent and complaint forms.
    [sbull] Intake forms with the potential for important consequences.
    [sbull] Written notices of eligibility criteria, rights, denial, 
loss, or decreases in benefits or services, actions affecting parental 
custody or child support, and other hearings.
    [sbull] Notices advising LEP persons of free language assistance.
    [sbull] Written tests that do not assess English language 
competency, but test competency for a particular license, job, or skill 
for which knowing English is not required.
    [sbull] Applications to participate in a recipient's program or 
activity or to receive recipient benefits or services.
    Nonvital written materials could include:
    [sbull] Hospital menus.
    [sbull] Third party documents, forms, or pamphlets distributed by a 
recipient as a public service.
    [sbull] For a non-governmental recipient, government documents and 
forms.
    [sbull] Large documents such as enrollment handbooks (although 
vital information contained in large documents may need to be 
translated).
    [sbull] General information about the program intended for 
informational purposes only.
    Into What Languages Should Documents be Translated? The languages 
spoken by the LEP individuals with whom the recipient has contact 
determine the languages into which vital documents should be 
translated. A distinction should be made, however, between languages 
that are frequently encountered by a recipient and less commonly-
encountered languages. Some recipients may serve communities in large 
cities or across the country. They regularly serve LEP persons who 
speak dozens and sometimes over 100 different languages. To translate 
all written materials into all of those languages is unrealistic. 
Although recent technological advances have made it easier for 
recipients to store and share translated documents, such an undertaking 
would incur substantial costs and require substantial resources. 
Nevertheless, well-substantiated claims of lack of resources to 
translate all vital documents into dozens of languages do not 
necessarily relieve the recipient of the obligation to translate those 
documents into at least several of the more frequently-encountered 
languages and to set benchmarks for continued translations into the 
remaining languages over time. As a result, the extent of the 
recipient's obligation to provide written translations of documents 
should be determined by the recipient on a case-by-case basis, looking 
at the totality of the circumstances in light of the four-factor 
analysis. Because translation is usually a one-time expense, 
consideration should be given to whether the up-front cost of 
translating a document (as opposed to oral interpretation) should be 
amortized over the likely lifespan of the document when applying this 
four-factor analysis.
    Safe Harbor. Many recipients would like to ensure with greater 
certainty that they comply with their Title VI obligations to provide 
written translations in languages other than English. Paragraphs (a) 
and (b) outline the circumstances that can provide a ``safe harbor'' 
for recipients regarding the requirements for translation of written 
materials. A ``safe harbor'' means that if a recipient provides written 
translations under these circumstances, such action will be considered 
strong evidence of compliance with the recipient's written-translation 
obligations.
    The failure to provide written translations under the circumstances 
outlined in paragraphs (a) and (b) does not mean there is non-
compliance. Rather, they provide a common starting point for recipients 
to consider whether and at what point the importance of the service, 
benefit, or activity involved; the nature of the information sought; 
and the number or proportion of LEP persons served call for written 
translations of commonly-used forms into frequently-encountered 
languages other than English. Thus, these paragraphs merely provide a 
guide for recipients that would like greater certainty of compliance 
than can be provided by a fact-intensive, four-factor analysis.
    Example: Even if the safe harbors are not used, if written 
translation of a certain document(s) would be so burdensome as to 
defeat the legitimate objectives of its program, the translation of the 
written materials is not necessary. Other ways of providing meaningful 
access, such as effective oral interpretation of certain vital 
documents, may be acceptable under such circumstances.
    Safe Harbor. The following actions will be considered strong 
evidence of compliance with the recipient's written-translation 
obligations:
    (a) The HHS recipient provides written translations of vital 
documents for each eligible LEP language group that constitutes five 
percent or 1,000, whichever is less, of the population of persons 
eligible to be served or likely to be affected or encountered. 
Translation of other documents, if needed, can be provided orally; or
    (b) If there are fewer than 50 persons in a language group that 
reaches the five percent trigger in (a), the recipient does not 
translate vital written materials but provides written notice in the 
primary language of the LEP language group of the right to receive 
competent oral interpretation of those written materials, free of cost.
    These safe harbor provisions apply to the translation of written 
documents only. They do not affect the requirement to provide 
meaningful access to LEP individuals through competent oral 
interpreters where an application of the four factor test leads to the 
determination that oral language services are needed and are 
reasonable. Conversely, oral interpretation of documents may not 
substitute for translation of vital written documents. For example, 
oral interpretation of the rules of a half-way house or residential 
treatment center may not substitute for translation of a short document 
containing the rules of the half-way house or residential treatment 
center and the consequences of violating those rules.

VII. Elements of Effective Plan on Language Assistance for LEP Persons

    If, after completing the four-factor analysis, a recipient 
determines that it should provide language assistance services, a 
recipient may develop an implementation plan to address the identified 
needs of the LEP populations it serves. Such recipients have 
considerable flexibility in developing this plan. The development and 
maintenance of a periodically updated written plan on language 
assistance for LEP persons (``LEP plan'') for use by a recipient's 
employees who serve or interact with the public could be an appropriate 
and cost-effective means of documenting compliance with Title VI and 
providing a framework for the provision of timely and reasonable 
language assistance. Moreover, such written plans may provide 
additional benefits to a recipient's managers in the areas of training, 
administration, planning, and budgeting. These benefits may lead 
recipients to document in a written LEP plan their language assistance 
services, and how staff and LEP persons can access those services. 
Despite these benefits, certain HHS

[[Page 47320]]

recipients, such as recipients serving very few LEP persons and 
recipients with very limited resources, may choose not to develop a 
written LEP plan. However, the absence of a written LEP plan does not 
obviate the underlying Title VI obligation to ensure meaningful access 
by LEP persons to a recipient's program or activities. Accordingly, in 
the event that a recipient elects not to develop a written plan, it may 
want to consider alternative and reasonable ways to articulate how it 
is providing meaningful access in compliance with Title VI. Entities 
having significant contact with LEP persons, such as schools, religious 
organizations, community groups, and groups working with new immigrants 
can be very helpful in providing important input into this planning 
process from the beginning.
    For the recipient who decides to develop a written implementation 
plan, the following five steps may be helpful in designing such a plan; 
they are typically part of effective implementation plans.

(1) Identifying LEP Individuals Who Need Language Assistance

    The first two factors in the four-factor analysis require an 
assessment of the number or proportion of LEP individuals eligible to 
be served or encountered and the frequency of encounters. Similarly, 
this step of an LEP implementation plan requires recipients to identify 
LEP persons with whom it has contact.
    One way to determine the language of communication is to use 
language identification cards (or ``I speak cards''), which invite LEP 
persons to identify their language needs to staff. Such cards, for 
instance, might say ``I speak Spanish'' in both Spanish and English, 
``I speak Vietnamese'' in both English and Vietnamese, etc. To reduce 
costs of compliance, the federal government has made a set of these 
cards available on the Internet. The Census Bureau ``I speak card'' can 
be found and downloaded at http://www.usdoj.gov/crt/cor/13166.htm, and 
accessed at http://www.lep.gov. When records are normally kept of past 
interactions with members of the public, the language of the LEP person 
can be included as part of the record. In addition to helping employees 
identify the language of LEP persons they encounter, this process will 
help in future applications of the first two factors of the four-factor 
analysis. In addition, posting notices in commonly encountered 
languages notifying LEP persons of language assistance will encourage 
them to identify themselves.

(2) Language Assistance Measures

    An effective LEP plan would likely include information about the 
ways in which language assistance will be provided. For instance, 
recipients may want to include information on at least the following:
    [sbull] Types of language services available.
    [sbull] How staff can obtain those services.
    [sbull] How to respond to LEP callers.
    [sbull] How to respond to written communications from LEP persons.
    [sbull] How to respond to LEP individuals who have in-person 
contact with recipient staff.
    [sbull] How to ensure competency of interpreters and translation 
services.

(3) Training Staff

    An effective LEP plan would likely include a process for 
identifying staff who need to be trained regarding the recipient's LEP 
plan, a process for training them, and the identification of the 
outcomes of the training. Staff should know their obligations to 
provide meaningful access to information and services for LEP persons. 
An effective LEP plan may include training to ensure that:
    [sbull] Staff know about LEP policies and procedures.
    [sbull] Staff having contact with the public are trained to work 
effectively with in-person and telephone interpreters.
    Recipients may want to include this training as part of the 
orientation for new employees. It may be important to take reasonable 
steps to see to it that all employees in public contact positions are 
properly trained. Recipients have flexibility in deciding the manner in 
which the training is provided. The more frequent the contact with LEP 
persons, the greater the need will be for in-depth training. Staff with 
little or no contact with LEP persons may only have to be aware of an 
LEP plan. However, management staff, even if they do not interact 
regularly with LEP persons, should be fully aware of and understand the 
plan so they can reinforce its importance and ensure its implementation 
by staff.

(4) Providing Notice to LEP Persons

    An effective LEP plan would likely include a description of the 
process by which to provide notice of the services that are available 
to the LEP persons it serves or, to the extent that a service area 
exists, that reside in its service area and are eligible for services. 
Once a recipient has decided, based on the four factors, that it will 
provide language services, it may be important for the recipient to let 
LEP persons know that those services are available and that they are 
free of charge. Recipients should provide this notice in a language LEP 
persons will understand. Examples of notification that recipients may 
want to consider include:
    [sbull] Posting signs in intake areas and other entry points. When 
language assistance is needed to ensure meaningful access to 
information and services, it is important to provide notice in 
appropriate languages in intake areas or initial points of contact so 
that LEP persons can learn how to access those language services. This 
is particularly true in areas with high volumes of LEP persons seeking 
access to certain health, safety, or public benefits and services, or 
activities run by HHS recipients. For instance, signs in intake offices 
could state that free language assistance is available. The signs 
should be translated into the most common languages encountered. They 
should explain how to get the language help.\11\
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    \11\ The Social Security Administration has made such signs 
available at http://www.ssa.gov/multilanguage/langlist1.htm, which 
also can be accessed at http://www.lep.gov. These signs could, for 
example, be modified for recipient use.
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    [sbull] Stating in outreach documents that language services are 
available from the recipient. Announcements could be in, for instance, 
brochures, booklets, and in outreach and recruitment information. These 
statements should be translated into the most common languages and 
could be ``tagged'' onto the front of common documents.
    [sbull] Working with community-based organizations and other 
stakeholders to inform LEP individuals of the recipients' services, 
including the availability of language assistance services.
    [sbull] Using a telephone voice mail menu. The menu could be in the 
most common languages encountered, and provide information about 
available language assistance services and how to get them.
    [sbull] Including notices in local newspapers in languages other 
than English.
    [sbull] Providing notices on non-English-language radio and 
television stations about the available language assistance services 
and how to get them.
    [sbull] Presentations and/or notices at schools and religious 
organizations.

(5) Monitoring and Updating the LEP Plan

    An effective LEP plan would likely include a process for a 
recipient to monitor its implementation of its plan and for updating 
its plan as necessary. For example, determining, on an ongoing basis, 
whether new documents,

[[Page 47321]]

programs, services, and activities need to be made accessible for LEP 
individuals may be appropriate, and recipients may want to provide 
notice of any changes in services to the LEP public and to employees. 
In addition, changes in demographics, types of services, or other needs 
may require annual reevaluation of an LEP plan. Less frequent 
reevaluation may be more appropriate where demographics, services, and 
needs are more static. One good way to evaluate the LEP plan may be to 
seek feedback from the community.
    In their reviews, recipients may want to consider assessing changes 
in:
    [sbull] Current LEP populations in service area or population 
affected or encountered.
    [sbull] Frequency of encounters with LEP language groups.
    [sbull] Nature and importance of activities to LEP persons.
    [sbull] Availability of resources, including technological advances 
and sources of additional resources, and the costs imposed.
    [sbull] Whether existing assistance is meeting the needs of LEP 
persons.
    [sbull] Whether staff knows and understands the LEP plan and how to 
implement it.
    [sbull] Whether identified sources for assistance are still 
available and viable.
    In addition to these five elements, effective plans set clear goals 
and establish management accountability. Some recipients may also want 
to consider whether they should provide opportunities for community 
input and planning throughout the process.

VIII. Voluntary Compliance Effort

    The goal for Title VI and Title VI regulatory enforcement is to 
achieve voluntary compliance. The requirement to provide meaningful 
access to LEP persons is enforced and implemented by the HHS Office for 
Civil Rights through the procedures identified in the Title VI 
regulations. These procedures include complaint investigations, 
compliance reviews, efforts to secure voluntary compliance, and 
technical assistance.
    The Office for Civil Rights, and the entire Department, are 
committed to assisting recipients of HHS financial assistance in 
complying with their obligations under Title VI of the Civil Rights Act 
of 1964. HHS believes that, on the whole, its recipients genuinely 
desire to comply with their obligations, but that some may lack 
knowledge of what is required of them or information concerning the 
resources that are available to them that would assist in meeting their 
Title VI obligations. Accordingly, HHS is committed to engaging in 
outreach to its recipients and to being responsive to inquiries from 
its recipients. Through its Administration on Children and Families, 
Administration on Health Care Quality and Research, Administration on 
Aging, Centers for Medicare and Medicaid Services, Health Resources 
Services Administration, Office for Civil Rights, and Office of 
Minority Health, HHS provides a variety of practical technical 
assistance to recipients to assist them in serving LEP persons. This 
technical assistance includes translated forms and vital documents; 
training and information about best practices; and grants and model 
demonstration funds for LEP services. HHS also provides a variety of 
services for LEP persons who come in contact with the Department. These 
services include oral language assistance services such as language 
lines and interpreters, translation of written materials, and foreign 
language Web sites.
    Further, HHS is committed to working with representatives of state 
and local health and social service agencies, organizations of such 
agencies, hospital associations, medical and dental associations and 
managed care organization to identify and share model plans, examples 
of best practices, cost-saving approaches, and information on other 
available resources, and to mobilize these organizations, to educate 
their members on these matters.
    HHS continues to explore how it can share with its recipients 
language assistance measures, resources, cost-containment approaches, 
and other information and knowledge, developed with respect to its own 
federally conducted programs and activities, and welcomes suggestions 
and comments in this regard. The HHS Office for Civil Rights, in 
conjunction with other HHS components, through direct contact and its 
Web site at http://www.hhs/gov/ocr, will continue to provide technical 
assistance that assists HHS recipients in understanding and complying 
with their obligations under Title VI, and assists recipients and the 
public by identifying resources offered by the Office for Civil Rights 
and other HHS components that facilitate compliance with Title VI, with 
respect to LEP persons. This and other helpful information may also be 
accessed at http://www.lep.gov.
    The Title VI regulations provide that HHS will investigate whenever 
it receives a complaint, report, or other information that alleges or 
indicates possible noncompliance with Title VI or its regulations. If 
the investigation results in a finding of compliance, HHS will inform 
the recipient in writing of this determination, including the basis for 
the determination. However, if a case is fully investigated and results 
in a finding of noncompliance, HHS must inform the recipient of the 
noncompliance through a Letter of Findings that sets out the areas of 
noncompliance and the steps that must be taken to correct the 
noncompliance. It must attempt to secure voluntary compliance through 
informal means. If the matter cannot be resolved informally, HHS must 
secure compliance through the termination of federal assistance after 
the HHS recipient has been given an opportunity for an administrative 
hearing and/or by referring the matter to DOJ to seek injunctive relief 
or pursue other enforcement proceedings. HHS engages in voluntary 
compliance efforts and provides technical assistance to recipients at 
all stages of an investigation. During these efforts, HHS proposes 
reasonable timetables for achieving compliance and consults with and 
assists recipients in exploring cost-effective ways of coming into 
compliance. In determining a recipient's compliance with the Title VI 
regulations, HHS's primary concern is to ensure that the recipient's 
policies and procedures provide meaningful access for LEP persons to 
the recipient's programs and activities.
    While all recipients must work toward building systems that will 
ensure access for LEP individuals, HHS acknowledges that the 
implementation of a comprehensive system to serve LEP individuals is a 
process and that a system will evolve over time as it is implemented 
and periodically reevaluated. As recipients take reasonable steps to 
provide meaningful access to federally assisted programs and activities 
for LEP persons, HHS will look favorably on intermediate steps 
recipients take that are consistent with this Guidance, and that, as 
part of a broader implementation plan or schedule, move their service 
delivery system toward providing full access to LEP persons. This does 
not excuse noncompliance with Title VI, but instead recognizes that 
full compliance in all areas of a recipient's activities and for all 
potential language minority groups may reasonably require a series of 
implementing actions over a period of time. However, in developing any 
phased implementation schedule, HHS recipients should ensure that the 
provision of appropriate assistance for significant LEP populations or 
with respect to activities having a significant impact on the health, 
safety, legal rights, or livelihood of beneficiaries is addressed 
first. Recipients are

[[Page 47322]]

encouraged to document their efforts to provide LEP persons with 
meaningful access to federally assisted programs and activities.

Appendix A

Questions and Answers Regarding the Department of Health and Human 
Services Guidance to Federal Financial Assistance Recipients Regarding 
the Title VI Prohibition Against National Origin Discrimination 
Affecting Limited English Proficient Persons

    1. Q. What is the purpose of the guidance on language access 
released by the Department of Health and Human Services (HHS)?
    A. The purpose of the Policy Guidance is to clarify to members 
of the public, and to providers of health and social services who 
receive Federal financial assistance from HHS, the responsibility of 
such providers to Limited English Proficient (LEP) persons, pursuant 
to Title VI of the Civil Rights Act of 1964. Among other things, 
this guidance clarifies existing legal requirements by providing a 
description of the factors providers of health and social services 
who receive Federal financial assistance from HHS should consider in 
determining and fulfilling their responsibilities to LEP persons 
under Title VI.
    2. Q. What does the policy guidance do?
    A. The policy guidance does the following:
    [sbull] Reiterates the principles of Title VI with respect to 
LEP persons.
    [sbull] Discusses the reasonable policies, procedures and other 
steps that recipients can take to ensure meaningful access to their 
program by LEP persons.
    [sbull] Clarifies that failure to take one or more of these 
steps does not necessarily mean noncompliance with Title VI.
    [sbull] Explains to recipients of Federal financial assistance 
that OCR will determine compliance on a case by case basis, in light 
of the following four factors: (1) The number or proportion of LEP 
persons eligible to be served or likely to be encountered by the 
program, activity or service provided by the recipient; (2) the 
frequency with which LEP individuals come in contact with the 
recipient's program, activity or service; (3) the nature and 
importance of the recipient's program, activity, or service; and (4) 
the resources available to the recipient and costs.
    [sbull] Provides that, based on these four factors, recipients 
with limited resources will not have the same compliance 
responsibilities applicable to recipients with greater resources. 
All recipients will have a great deal of flexibility in achieving 
compliance.
    [sbull] Provides that OCR will offer extensive technical 
assistance for recipients.
    3. Q. Does the guidance impose new requirements on recipients?
    A. No. Since its enactment, Title VI of the Civil Rights Act of 
1964 has prohibited discrimination on the basis of race, color or 
national origin in any program or activity that receives Federal 
financial assistance. Title VI requires that recipients take 
reasonable steps to ensure meaningful access to their programs and 
activities by LEP persons. Over the past three decades, OCR has 
conducted thousands of investigations and reviews involving language 
differences that affect the access of LEP persons to medical care 
and social services. This guidance synthesizes the legal 
requirements that OCR has been enforcing for over three decades.
    4. Q. Who is covered by the guidance?
    A. Covered entities include any state or local agency, private 
institution or organization, or any public or private individual 
that (1) Operates, provides or engages in health, or social service 
programs and activities, and (2) receives Federal financial 
assistance from HHS directly or through another recipient/covered 
entity. Examples of covered entities include but are not limited to 
the following entities, which may receive federal financial 
assistance: hospitals, nursing homes, home health agencies, managed 
care organizations, universities and other entities with health or 
social service research programs; state, county and local health 
agencies; state Medicaid agencies; state, county and local welfare 
agencies; federally-funded programs for families, youth and 
children; Head Start programs; public and private contractors, 
subcontractors and vendors; physicians; and other providers who 
receive Federal financial assistance from HHS.
    5. Q. How does the guidance affect small practitioners and 
providers who are recipients of federal financial assistance?
    A. Small practitioners and providers will have considerable 
flexibility in determining precisely how to fulfill their 
obligations to take reasonable steps to ensure meaningful access for 
persons with limited English proficiency. OCR will assess compliance 
on a case by case basis and will take into account the following 
factors: (1) The number or proportion of LEP persons eligible to be 
served or likely to be encountered by the recipient's program, 
activity or service; (2) the frequency with which LEP individuals 
come in contact with the program, activity or service; (3) the 
nature and importance of the program, activity, or service provided 
by the recipient; and (4) the resources available to the recipient 
and costs. There is no ``one size fits all'' solution for Title VI 
compliance with respect to LEP persons, and what constitutes 
``reasonable steps'' for large providers may not be reasonable where 
small providers are concerned. Thus, smaller recipients with smaller 
budgets will not be expected to provide the same level of language 
services as larger recipients with larger budgets. OCR will continue 
to be available to provide technical assistance to HHS recipients, 
including sole practitioners and other small recipients, seeking to 
operate an effective language assistance program and to comply with 
Title VI.
    6. Q. The guidance identifies some specific circumstances which 
OCR will consider to be strong evidence that a program is in 
compliance with its obligation under Title VI to provide written 
materials in languages other than English. Does this mean that a 
recipient/covered entity will be considered out of compliance with 
Title VI if its program does not fall within these circumstances?
    A. No. The circumstances outlined in the guidance are intended 
to identify circumstances which amount to a ``safe harbor'' for 
recipients who desire greater certainty with respect to their 
obligations to provide written translations. This means that if a 
recipient provides written translations under these circumstances, 
such action will be considered strong evidence of compliance with 
the recipient's written-translation obligations. However, the 
failure to provide written translations under the circumstances 
outlined in the ``safe harbor''does not mean there is non-
compliance. Rather, the safe harbor provides a tool which recipients 
may use to consider whether the number or proportion of LEP persons 
served call for written translations of vital documents into 
frequently encountered languages other than English. However, even 
if the safe harbors are not used, if written translation of certain 
documents would be so financially burdensome as to defeat the 
legitimate objectives of its program, the translation of the written 
materials is not necessary. Other ways of providing meaningful 
access, such as effective oral interpretation of certain vital 
documents, might be acceptable under such circumstances when, upon 
application of the four factors, translation services are required.
    7. Q. The guidance makes reference to ``vital documents'' and 
notes that, in certain circumstances, a recipient/covered entity may 
have to translate such documents into other languages. What is a 
vital document?
    A. As clarified by the guidance, the extent of Title VI 
obligations will be evaluated based on a four-factor test including 
the nature or importance of the service. In this regard, the 
guidance points out that documents deemed ``vital'' to the access of 
LEP persons to programs and services may often have to be 
translated. Whether or not a document (or the information it 
contains or solicits) is ``vital'' may depend upon the importance of 
the program, information, encounter, or service involved, and the 
consequence to the LEP person if the information in question is not 
provided accurately or in a timely manner. Where appropriate, 
recipients are encouraged to create a plan for consistently 
determining, over time and across their various activities, what 
documents are ``vital'' to the meaningful access of the LEP 
populations they serve. Thus, vital documents could include, for 
instance, consent and complaint forms, intake forms with potential 
for important health consequences, written notices of eligibility 
criteria, rights, denial, loss, or decreases in benefits or 
services, actions affecting parental custody or child support, and 
other hearings, notices advising LEP persons of free language 
assistance, written tests that do not assess English language 
competency, but test competency for a particular license, job or 
skill for which knowing English is not required, or applications to 
participate in a recipient's program or activity or to receive 
recipient benefits or services.
    8. Q. Will recipient/covered entities have to translate large 
documents such as managed care enrollment handbooks?
    A. Not necessarily. Some large documents may contain no vital 
information, and others will contain vital information that will 
have to be translated. Again, the obligation to

[[Page 47323]]

translate will depend on application of the four factors. In this 
context, vital information may include, for instance, the provision 
of information in appropriate languages other than English, or 
identifying where a LEP person might obtain an interpretation or 
translation of the document. However, depending on the 
circumstances, large documents such as enrollment handbooks may not 
need to be translated or may not need to be translated in their 
entirety.
    9. Q. May an LEP person use a family member or friend as his or 
her interpreter?
    A. Some LEP persons may feel more comfortable when a trusted 
family member or friend acts as an interpreter. When an LEP person 
attempts to access the services of a recipient of federal financial 
assistance, who upon application of the four factors is required to 
provide an interpreter, the recipient should make the LEP person 
aware that he or she has the option of having the recipient provide 
an interpreter for him/her without charge, or of using his/her own 
interpreter. Recipients should also consider the special 
circumstances discussed in the guidance that may affect whether a 
family member or friend should serve as an interpreter, such as 
whether the situation is an emergency, and concerns over competency, 
confidentiality, privacy, or conflict of interest.
    10. Q. May a recipient/covered entity require a LEP person to 
use a family member or a friend as his or her interpreter?
    A. No.
    11. Q. How does low health literacy, non-literacy, non-written 
languages, blindness and deafness among LEP populations affect the 
responsibilities of federal fund recipients?
    A. Effective communication in any language requires an 
understanding of the literacy levels of the eligible populations. 
However, where a LEP individual has a limited understanding of 
health matters or cannot read, access to the program is complicated 
by factors not generally directly related to national origin or 
language and thus is not a Title VI issue. Under these 
circumstances, a recipient should provide remedial health 
information to the same extent that it would provide such 
information to English-speakers. Similarly, a recipient should 
assist LEP individuals who cannot read in understanding written 
materials as it would non-literate English-speakers. A non-written 
language precludes the translation of documents, but does not affect 
the responsibility of the recipient to communicate the vital 
information contained in the document or to provide notice of the 
availability of oral translation. Of course, other law may be 
implicated in this context. For instance, Section 504 of the 
Rehabilitation Act of 1973 requires that federal fund recipients 
provide sign language and oral interpreters for people who have 
hearing impairments and provide materials in alternative formats 
such as in large print, braille or on tape for individuals with 
visual impairments; and the Americans with Disabilities Act imposes 
similar requirements on health and human service providers.
    12. Q. What assistance is available to help to recipients who 
wish to come into compliance with Title VI?
    A. For over three decades, OCR has provided substantial 
technical assistance to recipient/covered entities who are seeking 
to ensure that LEP persons can meaningfully access their programs or 
services. Our regional staff is prepared to work with recipients to 
help them meet their obligations under Title VI. As part of its 
technical assistance services, OCR can help identify best practices 
and successful strategies used by other federal fund recipients, 
identify sources of federal reimbursement for translation services, 
and point providers to other resources.
    In addition, the entire Department is also committed to 
assisting recipients of HHS financial assistance in complying with 
their obligations under Title VI of the Civil Rights Act of 1964. 
Through its Administration on Children and Families, Administration 
on Health Care Quality and Research, Administration on Aging, 
Centers for Medicare and Medicaid Services, Health Resources and 
Services Administration, Office for Civil Rights, Office of Minority 
Health and Substance Abuse and Mental Health Services 
Administration, HHS provides a variety of practical technical 
assistance to recipients to assist them in serving LEP persons. This 
technical assistance includes translated forms and vital documents; 
training and information about best practices; and grants and model 
demonstration funds for LEP services. HHS believes that, on the 
whole, its recipients genuinely desire to comply with their 
obligations, and that increased understanding of compliance 
responsibilities and knowledge about cost-effective resources that 
are increasingly available to them, will assist recipients/covered 
entities in meeting Title VI obligations. Accordingly, HHS is 
committed to providing outreach to its recipients and to being 
responsive to queries from its recipients. It is also committed to 
working with representatives of state and local health and social 
service agencies, organizations of such agencies, hospital 
associations, medical and dental associations and managed care 
organizations to identify and share model plans, examples of best 
practices, cost-saving approaches, and information on other 
available resources, and to mobilize these organizations to educate 
their members on these matters. HHS will continue to promote best 
practices in language access and fund model demonstration programs 
in this area. The HHS Office for Civil Rights, in conjunction with 
other HHS components, will continue to provide technical assistance 
and outreach to HHS recipients to assist them in understanding and 
complying with their obligations under Title VI and to provide 
information to recipients and the public through its Web site at 
http://www.hhs/gov/ocr. LEP information and resources can also be 
found at http://www.lep.gov.
    13. Q. How will OCR enforce compliance by recipient/covered 
entities with the LEP requirements of Title VI?
    A. The goal for Title VI and Title VI regulatory enforcement is 
to achieve voluntary compliance. The requirement to take reasonable 
steps to provide meaningful access to LEP persons is enforced and 
implemented by OCR through the procedures identified in the Title VI 
regulations. These procedures include complaint investigations, 
compliance reviews, efforts to secure voluntary compliance, and 
technical assistance.
    The Title VI regulations provide that OCR will investigate 
whenever it receives a complaint, report, or other information that 
alleges or indicates possible noncompliance with Title VI or its 
regulations. If the investigation results in a finding of 
compliance, OCR will inform the recipient in writing of this 
determination, including the basis for the determination. However, 
if a case is fully investigated and results in a finding of 
noncompliance, OCR must inform the recipient of the noncompliance 
through a Letter of Findings that sets out the areas of 
noncompliance and the steps that must be taken to correct the 
noncompliance. It must attempt to secure voluntary compliance 
through informal means. If the matter cannot be resolved informally, 
OCR may secure compliance through the termination of federal 
assistance after the recipient has been given an opportunity for an 
administrative hearing. OCR may also refer the matter to the 
Department of Justice to secure compliance through any other means 
authorized by law.
    At all stages of an investigation, OCR engages in voluntary 
compliance efforts and provides technical assistance to recipients. 
During these efforts, OCR proposes reasonable timetables for 
achieving compliance and consults with and assists recipients in 
exploring cost-effective ways of coming into compliance. In 
determining a recipient's compliance with the Title VI regulations, 
OCR's primary concern is to ensure that the recipient's policies and 
procedures contain reasonable steps to provide meaningful access for 
LEP persons to the recipient's programs, activities or services. As 
a result, the vast majority of all complaints have been resolved 
through such voluntary efforts.
    14. Q. Does issuing this guidance mean that OCR will be changing 
how it enforces compliance with Title VI?
    A. No. How OCR enforces Title VI is governed by the Title VI 
implementing regulations. The methods and procedures used to 
investigate and resolve complaints, and conduct compliance reviews, 
have not changed.
    15. Q. What is HHS doing to promote access for LEP persons to 
its own programs and services?
    A. HHS provides a variety of services for LEP persons who come 
in contact with the Department. These services include oral language 
assistance services such as language lines and interpreters; 
translation of written materials; and foreign language web sites. 
HHS will continue to explore how it can share with its recipients 
language assistance measures, resources, cost-containment 
approaches, and other information and knowledge, developed with 
respect to its own federally conducted programs and activities, and 
welcomes any suggestions in this regard.

[FR Doc. 03-20179 Filed 8-6-03; 8:45 am]
BILLING CODE 4153-01-P