Form CDTFA-254 "Language Access Complaint" - California

What Is Form CDTFA-254?

This is a legal form that was released by the California Department of Tax and Fee Administration - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2017;
  • The latest edition provided by the California Department of Tax and Fee Administration;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form CDTFA-254 by clicking the link below or browse more documents and templates provided by the California Department of Tax and Fee Administration.

ADVERTISEMENT
ADVERTISEMENT

Download Form CDTFA-254 "Language Access Complaint" - California

1416 times
Rate (4.4 / 5) 71 votes
CDTFA-254 REV. 1 (8-17)
STATE OF CALIFORNIA
LANGUAGE ACCESS COMPLAINT
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
NAME (first, last)
ADDRESS
CITY/STATE/ZIP
HOME PHONE (include area code)
BUSINESS PHONE (include area code)
(
)
(
)
PROGRAM OR OFFICE ALLEGEDLY IN VIOLATION
NAME OF THE CDTFA PROGRAM/OFFICE INVOLVED IN THE ALLEGED VIOLATION
NAME OF THE CDTFA EMPLOYEE INVOLVED IN THE ALLEGED VIOLATION
DATE ALLEGED VIOLATION OCCURRED
CHECK THE TYPE OF VIOLATION THAT OCCURRED:
Failure to make translated documents available
Interpreter services not provided
Service not timely
Interpreter or translators were not competent
Was unable to access services, programs or activities
Other:
Please provide a description of the alleged violation and requested remedy:
Have you attempted to resolve the problem with anyone at CDTFA?
Yes
No
If yes, please explain what steps you have taken to resolve the problem; and who at CDTFA has assisted you.
INSTRUCTIONS
Please complete, print, and send the form to the address listed below, or scan and email the form to: EEO@cdtfa.ca.gov.
California Department of Tax and Fee Administration
Equal Employment Opportunity Office – MIC 51
PO Box 942879
Sacramento, CA 94279-0051
SIGNATURE
DATE
CLEAR
PRINT
CDTFA-254 REV. 1 (8-17)
STATE OF CALIFORNIA
LANGUAGE ACCESS COMPLAINT
CALIFORNIA DEPARTMENT OF TAX AND FEE ADMINISTRATION
NAME (first, last)
ADDRESS
CITY/STATE/ZIP
HOME PHONE (include area code)
BUSINESS PHONE (include area code)
(
)
(
)
PROGRAM OR OFFICE ALLEGEDLY IN VIOLATION
NAME OF THE CDTFA PROGRAM/OFFICE INVOLVED IN THE ALLEGED VIOLATION
NAME OF THE CDTFA EMPLOYEE INVOLVED IN THE ALLEGED VIOLATION
DATE ALLEGED VIOLATION OCCURRED
CHECK THE TYPE OF VIOLATION THAT OCCURRED:
Failure to make translated documents available
Interpreter services not provided
Service not timely
Interpreter or translators were not competent
Was unable to access services, programs or activities
Other:
Please provide a description of the alleged violation and requested remedy:
Have you attempted to resolve the problem with anyone at CDTFA?
Yes
No
If yes, please explain what steps you have taken to resolve the problem; and who at CDTFA has assisted you.
INSTRUCTIONS
Please complete, print, and send the form to the address listed below, or scan and email the form to: EEO@cdtfa.ca.gov.
California Department of Tax and Fee Administration
Equal Employment Opportunity Office – MIC 51
PO Box 942879
Sacramento, CA 94279-0051
SIGNATURE
DATE
CLEAR
PRINT