Federal Coordination And Compliance Section

 [Federal Register: August 8, 2003 (Volume 68, Number 153)] [Notices]                [Page 47311-47323] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr08au03-65]                           ======================================================================= -----------------------------------------------------------------------  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.  -----------------------------------------------------------------------  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. ---------------------------------------------------------------------------      \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. ---------------------------------------------------------------------------      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://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=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. ---------------------------------------------------------------------------      \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. ---------------------------------------------------------------------------  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. ---------------------------------------------------------------------------      \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. ---------------------------------------------------------------------------      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\ ---------------------------------------------------------------------------      \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. ---------------------------------------------------------------------------      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\ ---------------------------------------------------------------------------      \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. ---------------------------------------------------------------------------      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. ---------------------------------------------------------------------------      \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. ---------------------------------------------------------------------------  (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. ---------------------------------------------------------------------------      \7\ Recipients with limited resources may find that entering  into a bulk telephonic interpretation service contract will prove  cost effective. ---------------------------------------------------------------------------  * * * * *     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\ ---------------------------------------------------------------------------      \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://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://www.usdoj.gov/crt/cor/13166.htm, and  accessed at http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=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\ ---------------------------------------------------------------------------      \11\ The Social Security Administration has made such signs  available at http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://www.ssa.gov/multilanguage/langlist1.htm, which  also can be accessed at http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://www.lep.gov. These signs could, for  example, be modified for recipient use. ---------------------------------------------------------------------------      [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://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=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://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=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://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=http://www.hhs/gov/ocr. LEP information and resources can also be  found at http://frwebgate.access.gpo.gov/cgi-bin/leaving.cgi?from=leavingFR.html&log=linklog&to=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 
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Updated August 6, 2015