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Appendix A to Part 92—Notice Informing Individuals About Nondiscrimination and Accessibility Requirements and Nondiscrimination Statement:

Discrimination is Against the Law

Horizon EyeCare Professionals complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Horizon EyeCare Professionals does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

  Horizon EyeCare Professionals:

Provides free aids and services to people with disabilities to communicate effectively with us, such as:

  •    Qualified sign language interpreters
  •    Written information in other formats (large print, audio, accessible electronic formats, other formats)

Provides free language services to people whose primary language is not English, such as:

  •   Qualified interpreters
  •   Information written in other languages

If you need these services, contact Terri Nelson, Office Manager

If you believe that Horizon EyeCare Professionals has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:

Civil Rights Coordinator: Terri Nelson, Office Manager

Address: 2560 Harvest Lane NW Owatonna NW 55060

Phone: (507) 451-3072

Fax: (507) 451-4291

Email: Horizoneyecaremn@gmail.com

You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Terri Nelson, Office Manager, is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Appendix B to Part 92—Tagline Informing Individuals With Limited English Proficiency of Language Assistance Services

ATTENTION:  If you have a language barrier to spoken English, language assistance services, free of charge, are available to you.

(English)

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística (Spanish)

注意:如果您使用繁體中文,您可以免費獲得語言援助服務.

(Chinese)

CHÚ Ý:  Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. (Vietnamese)

주의:  한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  (Korean)

PAUNAWA:  Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.

(Tagalog)

ВНИМАНИЕ:  Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.

(Russian)

ملاحظة: إذا كنت تتكلم العربية، تتوفر لك خدمات المساعدة اللغوية مجانا.

(Arabic)

ATANSYON:  Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou.

(Haitian/French Creole)

ATTENTION :  Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.

(French)

UWAGA:  Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.

(Polish)

ATENÇÃO:  Se fala português, encontram-se disponíveis serviços linguísticos, grátis.

(Portugese)

ATTENZIONE:  In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti.

(Italian)

ACHTUNG:  Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.

(German)

注意事項:日本語を話される場合、無料の言語支援をご利用いただけます。

(Japanese)

Xim: Yog hais tias koj tsis txawj lus Askiv, free kev pab txhais lus yog muaj.

(Hmong)

ប្រសិនបើអ្នកនិយាយក្រូអាត, សេវាភាសាដែលអាចប្រើបានដើម្បីឱ្យអ្នកដោយឥតគិតថ្លៃ។

(Cambodian)

አማርኛ መናገር ከሆነ, ነጻ ቋንቋ አገልግሎት ማግኘት ይቻላል.

(Amharic)

ຖ້າຫາກວ່າທ່ານເວົ້າພາສາລາວ, ການບໍລິການການຊ່ວຍເຫຼືອພາສາທີ່ມີຢູ່ສໍາລັບທ່ານ.

(Lao)