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Run: Title VI Limited English Proficiency Four-Factor Analysis Worksheet

Use this Title VI LEP Four-Factor Analysis Worksheet to document language access needs, prioritize translation, and record the action plan for vital document...

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Worksheet Overview

Program or Service Name (required)

Review Period Start Date (required)

Review Period End Date (required)

Service Area or Jurisdiction (required)

Reviewer Name (required)

Review Date (required)

Four-Factor Analysis

Factor 1: Number or Proportion of LEP Individuals Served or Encountered (required)

Summarize the LEP population served, including any available demographic or service data. Do not include names or other unnecessary PII.

Factor 2: Frequency of Contact with LEP Individuals (required)

Describe how often LEP individuals interact with the program, service, or staff.

Factor 3: Importance of the Program, Service, or Activity (required)

Explain the importance of the service to the public and the consequences if language access is not provided.

Factor 4: Resources Available and Costs (required)

Describe available language assistance resources, staffing, vendor support, and cost considerations.

Language Assistance Determination

Priority Languages for Language Assistance (required)

Select the languages most likely to require translated materials or interpretation support.

Overall Language Assistance Determination (required)

Interpretation Available for Oral Interactions? (required)

Written Translation Needed for Vital Documents? (required)

Notes on Determination

Vital Documents and Translation Priorities

Have Vital Documents Been Identified? (required)

Vital Documents

Translation Priority Notes

Explain why certain documents are prioritized, including any progressive disclosure decisions or phased translation plans.

Action Plan and Audit Trail

Action Items (required)

Next Review Date (required)

Audit Trail Notes

Record supporting references, data sources, or decisions needed for compliance documentation.

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