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Home My Public Portal Aboutr 19-202lboolu#tvn of foe �vrvug4 of aarftrd, �K� 51 No. 19 -202 Date of Adoption December 12, 2019 AUTHORIZING THE APPROPRIATE BOROUGH OFFICIALS TO APPROVE AND PARTICIPATE IN A NON - DISCRIMINATION POLICY IN ACCORDANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 AS AMENDED, IN CONNECTION WITH THE OPERATION OF THE BOROUGH SENIOR TRANSPORTATION PROGRAM WHEREAS, the Borough of Carteret receives grant funding through NJ Transit to operate its Senior Transportation Program; and WHEREAS, NJ Transit requires the Borough of Carteret to confirm that it complies with Title VI of the Civil Rights Act and that it will adopt and implement the policies set forth in the attached document entitled Borough of Carteret, Senior Transportation, Title VI Non - Discrimination Policy (the "Policy "); and WHEREAS, the Borough is willing to adopt the Policy to confirm its compliance with laws prohibiting discrimination NOW, THEREFORE, BE IT RESOLVED by the Mayor and Council of the Borough of Carteret, Middlesex County, State of New Jersey, that the Borough hereby adopts the attached Policy; and IT IS FURTHER RESOLVED that the Mayor and/or Appropriate Borough Officials are hereby authorized to execute any documents required in connection with the same. Adopted this 12 ° i day of December, 2019 and certified as a true copy of the original on December 13, 2019. CARMELA POGORZELSKI Acting Municipal Clerk RECORD OF COUNCIL VOTE COUNCILMAN YES NO NV A.B. COUNCILMAN YES NO NV A.B. BELLINO X JOHAL X DIAZ X KRUM X DIMASCIO NAPLES X X- Indicate Vote AB- Absent NV -Not Voting XOR - Indicates Vote to Overrule Ve Adopted at a meeting of the Municipal Council Dec nber 12 20.9 f P y � L.. 6.� ( "7d , .v -, .- ----.-rum- --- \ r HfHip ik f }urp llV, , nt ShGiNB Y fvivt,ly ;_1i dr d ri01,' i0r ifElinrr ` .t,utrr3v @ "t: I �S ` � Grt� December 6, 2019 Mr. Taqualla Lowman Borough of Carteret 61 Cooke Avenue Carteret, NJ 07008 RE: Title VI Program Plan Approval Dear: Ms. Lowman: IN rr r { r e 6 t Thank you for your continued cooperation through the Title VI Program Review process. All of the identified corrective actions have been made and findings have been closed. The final necessary element of your Title VI Program is approval by the Borough Council. Once you have received approval from your governing board through a board resolution, meeting minutes, or similar process, that document should be added as the final section of your Title VI Program and e- mailed to your Regional Program Administrator, at Lnwilliams @NJTransit.com Thank you for your continued commitment to community transportation. Sincerely, Zawt" 2f/1PCca#" Lauren Williams Central Regional Program Administrator Lanquane Assistance Plan OVERVIEW The first section in this document describes the purpose of the Language Assistance Plan (LAP). The second section in this document provides the four - factor Limited English Proficiency (LEP) analysis as outlined by the Department of Transportation (DOT) used to identify LEP needs and assistance measures. This analysis helps the Borough of Carteret office on Aging Transportation Program communicate effectively with persons with LEP or low literacy. The four - factor LEP analysis considers the following components: Factor 1: The number or proportion of LEP persons eligible to be served or likely to be encountered by the Borough of Carteret office on Aging Transportation Program. Factor 2: The frequency with which LEP persons come into contact with the Borough of Carteret office on Aging Transportation Program Factor 3: The nature and importance of the Borough of Carteret office on Aging Transportation Program, activities, programs and services to people's lives. Factor 4: The resources available to the recipient for LEP outreach and Borough of Carteret office on Aging Transportation Program, as well as the costs associated with that outreach. The third and final section discusses the implementation of the Language Assistance Plan, which includes methodologies for identifying LEP individuals, providing services, establishing policies, monitoring the LAP, and recommendations for future LAP implementations. Purpose of the Language Assistance Plan The limited English Proficiency Plan has been developed to address the Borough of Carteret office on Aging Transportation Program responsibilities as a sub - recipient of federal financial assistance as they relate to the needs of individuals with limited language skills. This plan has been prepared in accordance with Title VI of the Civil Rights Act of 1964; Federal Transit Administration Circular 4702.1B, dated October 1, 2012, which states that the level and quality of transportation service is provided without regard to race, color, or national origin. FTA Circular 4702AB was developed by the Federal Transit Administration (FTA) and details the administrative and reporting requirements for recipients of FTA financial assistance to comply with Title VI and related executive orders including LEP. One critical concern addressed by Title VI is the language barrier that Limited English Proficiency (LEP) persons face with respect to assessing information about using the transit service. Transit operators must ensure that this group has adequate access to the agency's programs and activities, including public participation opportunities. Executive Order 13166, titled, "Improving Access to Services for persons with Limited English Proficiency," indicates that differing treatment based upon a person's inability to speak, read, write or understand English is a type of national origin discrimination. It directs each federal agency to publish guidance for its respective recipients clarifying their obligation to ensure that such discriminations do not take place. This order applies to all state and local agencies which receive federal funding. Borough of Carteret office on Aging Transportation Program has developed this plan to help identify reasonable steps for providing language assistance to persons with limited English proficiency who wish to access services provided by the Borough of Carteret office on Aging Transportation Program. This document is also consistent with the U.S. Department of Justice's guidelines on self- assessment, which are contained in the Language Access Assessment and Planning Tool for Federally Conducted and Federally Assisted Programs. Four Factor Analysis Factor 1: The number or proportion of LEP persons eligible to be served or likely to be encountered by the Borough of Carteret office on Aging Transportation Program Borough of Carteret office on Aging Transportation Program holds a unique position in regard to meeting Title VI requirements. As a sub - recipient of FTA 5310 Grant funding, the agency's focus is primarily to transport Borough of Carteret Seniors residents 60 years of age and older to the senior center or to non - emergency medical or shopping appointments. This service is provided to these seniors because they may be unable to drive, transit options are insufficient and or do not exist in their area. Borough of Carteret office on Aging Transportation Program does not offer transportation to the general public other than in situation involving coordinated plan with other entities. Most persons join the Borough of Carteret office on Aging Transportation Program through an application process, and all passengers must be residents of the Borough of Carteret. Residents can apply for transportation services by coming to the Borough of Carteret Senior Center or the Carteret Health department and joining and or by calling via phone to our transportation coordinator /staff. Interested individuals can also receive a membership card during our onsite visits. Interpreters are available upon request to translate and answer individual's questions. Once an application has been completed and meets our membership criteria of 60 years of age and a resident of the Borough of Carteret hey may schedule their rides in our vehicles as needed. Safe Harbor Provision The Federal Transit Authority Circular 4702.1 B states: "DOT has adopted DOTs Safe Harbor Provision, which outlines circumstances that can provide a "Safe Harbor' for recipients regarding translation of written materials for LEP populations. The Safe Harbor Provision stipulates that if a recipient provides written translations of vital documents for each eligible LEP language group that constitutes five (5 %) or 1,000 persons, whichever is less, of the total population of persons eligible to be served or likely to be affected or encounters, then such action will be considered strong evidence of compliance with the recipient's written translation obligations. Translation of non -vital documents, if needed, can be provided orally. If there are fewer than 50 persons in a language group that reaches the five percent (5 %) trigger, the recipient is not required to translate vital written materials but should provide notice in the primary language of the LEP language group of the right to receive competent oral translation of those written materials, free of cost. These Safe Harbor Provisions apply to the translations of written documents only. They do not affect requirement to provide meaningful access to LEP individuals through competent oral interpreters where oral language services are needed and are reasonable. A recipient may determine, based on the Four Factor Analysis that even though a language group meets the threshold specified by the Safe Harbor Provision, written translation may not be an effective means to provide language assistance measures. For example, a recipient may determine that a large number of persons in that language group have low literacy skills in their native language and therefore require oral interpretation. In such cases, background documentation regarding the determination shall be provided to FTA in the Title VI program. The Borough of Carteret obtained information from the U.S. Census Bureau's American Fact Finder in the section "Profile of General Population and Housing Characteristics: 2010 Demographic Profile Data. Language information was obtained from "Selected Social Characteristics in the United States 2009 -2013 American Community Survey 5 -year estimates, in order to determine the population of LEP persons within the jurisdiction and the primary language spoken. The US Census Bureau 2009 -2013 American Community Survey estimates that at the time of the survey Borough of Carteret had a total population of 22,844 of whom 21,308 were individuals age 5 years and older. Of this population, 61.7% speak only English, while the remaining 38.3% speak other languages, either in addition to or instead of English. In the Borough of Carteret, 17.4% of the total population represents the LEP population, that is, English is not their primary language and they speak English "less than very well." Factor 2: The frequency with which LEP Persons come into contact with the Borough of Carteret Division of Senior & Veterans Services Transportation program. Individuals with limited English proficiency may inquire about use and are affected by service that the Borough of Carteret office on Aging Transportation Program provides on a daily basis. Operational services include by appointment only, transportation services to the senior center, medical and shopping appointments for residents 60 years of age and older. Individuals with limited English proficiency also come into contact with the Borough of Carteret office on Aging Transportation Program by calling the customer service telephone line, visiting the facility, and using the website. A significant part of the development of the Borough of Carteret office on Aging Transportation Program's language assistance plan is the assessment of major points of contact, which include, but are not necessarily limited to, the following: (1) communication with customer service staff; (2) printed outreach materials; (3) website; and (4) local advertising. To better understand the frequency with which LEP riders come into contact with the Borough of Carteret office on Aging Transportation Program, Borough of Carteret office on Aging Transportation Program conducted internal informal surveys of customer service staff, reservation agents, administrative staff and drivers. Borough of Carteret office on Aging Transportation Program assessed the frequency their staff has or could come into contact with LEP persons over the past 10 years. The result of the report is that there were no individuals participating or wishing to participate in the program with Limited English Proficiency that we were unable to communicate with. Factor 3: The nature and importance of the program, activity, or service provided by the program to people's lives. The primary purpose of the Borough of Carteret Office on Aging Transportation Program is to provide appropriate and adequate transportation for seniors who live in the Borough of Carteret. The program provides vital transportation for seniors to and from their medical appointments, food shopping trips and to nutrition programs at the Borough of Carteret Community Center. Factor 4: The resources available to recipient for LEP outreach, as well as the costs associated with that outreach. Borough of Carteret office on Aging Transportation Program is committed to providing language assistance to LEP populations who need services to gain access to the transportation program. The Borough currently has employees who are fluent in both Spanish and Punjabi who are able to translate for those clients whom may not be fluent in English. We distribute material printed in both Spanish and Punjabi Summary The summary of the four - factor analysis is identified by the following: (1) No "true" LEP participants have been served in the past 10 years. (2) No participant was underserved by the Borough of Carteret office on Aging Transportation Program due to language barriers. (3) The other languages spoken in the Borough of Carteret that meet the Safe Harbor Provision are Spanish and Other Indo- European languages. Language Assistance Implementation Plan Methodologies: Identifying LEP Individuals The evidence of the Four Factor Analysis, very few LEP individuals are referred to or participate in the Borough of Carteret office on Aging Transportation Program. There are a few languages spoken in Borough of Carteret; Spanish and other Indo- European languages that meet the Safe Harbor threshold. There does not seem to be a barrier at this time with individuals applying for the program or for participants currently enrolled in the program. For the past 10 years the Borough of Carteret office on Aging Transportation Program has not failed to provide services to individuals in Borough of Carteret. Carteret borough, New Jersey Estimate Margin of Error Total: 21,859 +/_300 Speak only English 10,710 +/ -851 Spanish or Spanish Creole: 5,932 +/ -742 Speak English "very well" 3,571 +/-629 Speak English less than "very well" 2,361 +/ -384 Language Assistance Implementation Plan Methodologies: Identifying LEP Individuals The evidence of the Four Factor Analysis, very few LEP individuals are referred to or participate in the Borough of Carteret office on Aging Transportation Program. There are a few languages spoken in Borough of Carteret; Spanish and other Indo- European languages that meet the Safe Harbor threshold. There does not seem to be a barrier at this time with individuals applying for the program or for participants currently enrolled in the program. For the past 10 years the Borough of Carteret office on Aging Transportation Program has not failed to provide services to individuals in Borough of Carteret. Providing Services Borough of Carteret office on Aging Transportation Program currently does not have a need for professional translation services however it does have volunteers that are available for translation if the need arises. The following documents are made available to the public in Spanish and Punjabi and upon request any other Indo - European language: Title VI Notice to the Public, Title VI Complaint Procedure, Title VI complain Form Communicating Availability of Language Assistance Borough of Carteret office on Aging Transportation Program provides notice to LEP persons of the availability of language assistance through posting of our services at our facility, on our website, in our newsletters and in our community partner's newsletters, through our HUD office and community centers and through public meeting with our local county and community partners. Individuals seeking to become participants in the Borough of Carteret office on Aging Transportation Program may call the customer service telephone number or visit the facility and apply and reserve a ride with the transportation coordinator /staff. Monitoring Borough of Carteret office on Aging Transportation Program evaluates itself on the feedback from the participants in the program. The Administrators frequently meets with staff for any potential issues or problems. The transportation staff evaluates the program annually to find out areas it can improve upon. The Title VI plan will be evaluated annually and will be updated every three years. Elements of evaluation may include: (1) Signs to be posted in the entry areas regarding the availability of services that are free of charge. (2) Website, documents, and brochures are offered or printed in the alternative language and includes a statement that, language services are available and free of charge. (3) Staff also informs LEP persons that language assistance is available and free of charge. Employee Training Borough of Carteret office on Aging Transportation Program conducts monthly in- service training for staff which include driver and passenger safety, customer service and language assistance training. Additionally, all staff of the Borough of Carteret receives training during employee orientation and throughout their course of employment to better equip them in the provision of efficient services to our residents. Membership of Non - elected Committees and Councils Borough of Carteret office on Aging Transportation Program does not have a board of non - elected officials at this time. Title VI Equity Analysis The Borough of Carteret Division of Senior & Veterans Services Transportation Program does not have transit related facilities. Table Depicting Minority Representation on Decision - Making Bodies Subrecipients that have transit- related, non - elected planning boards, advisory councils or committees, or similar bodies, the membership of which is selected by the subrecipient, must provide a table depicting the membership of those committees broken down by race, and a description of efforts made to encourage the participation of minorities on such committees. 'Borough of Carteret' Board Minority Representation Analysis Body Caucasian Latino African American Asian Native American INSERT RACE INSERT RACE Borough Council 3 2 1 Title VI Plan - Public Participation Plan Element The federal Transit Administration (FTA) requires that the Title V program includes a public participation plan that includes an outreach plan to engage minority and limited English proficient (LEP) populations. The plan may include other constituencies that are traditionally undeserved, such as people with disabilities, low- income populations, and other. Applicants to New Jersey Transit FTA assistance are required to comply with several requirements that help meet this Title VI requirement. These requirements include the published notice of intent to apply to New Jersey Transit for FTA assistance and participation in the public transit- human services transportation coordinated plan development. Other public transportation methods include Board /Council meetings, Council meetings of cities and counties that provide local funding, advisory committees, public involvement efforts for transportation services, passenger surveys, ,marketing efforts, such as booths at fairs, and presentations to service and other organizations. Describe your agency's participation in the following list of items to explain your public participation element. • Are Board /council meetings open to the public? Yes • How do you publicize the dates, times and locations of Board /council meetings? They are posted on bulletin boards as well as advertised in the newspapers • Where are Board /council meetings held? Thomas J. Deverin Community Center /Library, Carteret Municipal Building, Carteret Municipal Court. • Is the location accessible to persons with disabilities? Yes • Is the location served by your agency's transportation services during the hours Board /Council meetings are held? No, however we do offer transportation to the meetings upon request. • What efforts do you undertake to ensure that transportation riders or clients can attend Board /council meetings? We distribute a monthly calendar with the dates that allows riders /clients to complete and request transportation to Board /council meetings • Do you rely on any counties or cites for funding? Yes, interested parties can attend Board/council /agenda meetings to comment on the budget. Are you receiving funding from the county or other surrounding cities? yes • Discuss any other outreach efforts, including transportation advisory committees, procedures for soliciting comments for service changes, passenger surveys, public involvement for transportation services presentations etc. We post notices in the senior center and library. Surveys and information about our programing and services are distributed at town wide events, senior developments, to organizations who cater to the disabled, senior meetings, as well as on our website, which we are in the process of updating, TV 36 and in various town wide mailers. Borough of Carteret Title VI Plan NOTICE TO BENEFICIENCES NON - DISCRIMINATION POLICY BOROUGH OF CARTERET, OFFICE ON AGING, SENIOR TRANSPORTATION is committed to ensuring that no person is excluded from, or denied the benefits of our services on the basis of race, color, or national origin as protected by Title VI of the Civil Rights Act of 1964, as amended. Any person who believes that they have, individually, or as a member of any specific class of persons, been subjected to discrimination on the basis of race, color, or national origin, may file a complaint in writing to BOROUGH OF CARTERET, OFFICE ON AGING, SENIOR TRANSPORTATION. To file a complaint, or for more Information on BOROUGH OF CARTERET, OFFICE ON AGING, SENIOR TRANSPORTATION's obligations under Title VI write to: 100 Cooke Avenue, Carteret, New Jersey 07008. Transportation services provided by this agency are in whole or part funded through federal funds received through NJ TRANSIT and as an individual you also have the right to file your complaint to both BOROUGH OF CARTERET, OFFICE ON AGING, SENIOR TRANSPORTATION, as well as the Federal Transit Administration. Complaints may also be filed with the Federal Transit Administration in writing and may be addressed to: Title VI Program Coordinator East Building, 5`" Floor — TCR, U.S. Department of Transportation, Federal Transit Administration, Office of Civil Rights, 1200 New Jersey Avenue, SE, Washington, DC 20590. Posted: 1. Bulletin Board 2. Each transportation vehicle Office on Aging 100 Cooke Ave. Carteret, NJ, 07008 Si necesita mas information en otro idioma, Ilame a (732- 541 -3890) Z ' fk* 3rLT aim 4, uiwwh Zft 3ird @ZF-f;ai'k ct #q* zF (732 -541 -3890) If you need more information in another language, call (732 -541 -3890) AVISO A BENEFICIENCES POL(ZA DE NO DISCRIMINACON Condado de Carteret, oficina de envejecimiento, transporte de Mayores opera sus programas y servicios sin consideracion a raza, color o origen nacional con arreglo al titulo VI de la ley de derechos civiles de 1964, enmendada. Cualquier persona que tree que el o ella ha sido agraviado por cualquier pr6ctica discriminatoria ilegal bajo el titulo VI puede presentar una queja a la ciudad de Carteret, oficina de envejecimiento, transporte de Mayores. Para presentar una queja o para obtener m6s informacidn sobre Condado de Carteret, oficina de envejecimiento, transporte de Mayores obligaciones debajo titulo VI escriben a: (61 Cooke Avenue Carteret, NJ 07008 atenci6n ciudad de Carteret, oficina de envejecimiento, transporte de Mayores o visita www.Carteret.net. Servicios de transporte prestados por esta agencia son total o parcialmente financiado mediante fondos federales recibidos a trav6s de NJ Transit y como individuo tambi6n tiene el derecho a presentar su queja a ambos Condado de Carteret, oficina en Envejecimiento, transporte de Mayores, asi como la Administracidn Federal de tr6nsito. Quejas tambien pueden presentarse con la administraci6n de transito Federal y puede ser dirigidas a: Coordinadora del programa Titulo VI, edificio este, 5th Floor — TCR, Departamento de transporte de Et1A, administraci6n federal del transporte, oficina de Derechos Civiles, 1200 New Jersey Avenue, SE, Washington, DC 20590. , Si necesita mas informacidn en otro idioma, Ilame a (732 -541 -3890) lir��i�>Jt� i�li�r�r zT::zrr�r ar �rr13T u4,3flfi gfi-.F vl wcT6� f�Ffr 3T;:'1 ar3` r <: a naafi 3i3---qw ;Fr tftF fir: arzr::T., fir r �Fq at vEF 2frzfi� z�* zF;T;P�f ur;: u, VfGT Wes, af3T76 fly < ' , zr (:aTftW ... , ,.• •o i'i, zF)4t 'w 'l1C dw, 3Mf TTTaZ,4 ftv6 q ft c i o oi wU Cryg7r,°;31�T�1i-'z'Awiw'•� F {: sit l "0 Trizk$ vsf gljf zR 4R2i-war - frO(# Of�ir @r-T w u..m Rr ra &Tc: e. aff zRt URwW ff df AT w �i � f �rw a,:uw�r;:,O Wt* w& H � , t-+z fir, 5 ZF nFum - ft*3Trz, 3Tat<*r uf3a oa fir, 7'-If u;.TFrTa mwgF, f u 3TMWR, 120o ;�w ur* vb�w TF#, arR*Z'Wr, 94::!205 9 0 zrf� fgFfr 3T,-w 3T( -,w4 zit 3ifd3WW r i Tt (732- 541 -3890) Title VI Complaint Procedure Any person who believes she or he has been discriminated against on the basis of race, color, or national origin by the Borough of Carteret (hereinafter referred to as "the Authority ") may file a Title VI complaint by completing and submitting the agency's Title VI Complaint Form. Borough of Carteret investigates complaints received no more than 180 days after the alleged incident. The Authority will process complaints that are complete. Once the complaint is received, the Authority will review it to determine if our office has jurisdiction. The complainant will receive an acknowledgement letter informing her /him whether the complaint will be investigated by our office. The Authority has (7) seven days to investigate the complaint. If more information is needed to resolve the case, the Authority may contact the complainant. The complainant has (7) seven business days from the date of the letter to send requested information to the investigator assigned to the case. If the investigator is not contacted by the complainant or does not receive the additional Information within (7) seven business days, the Authority can administratively close the case. A case can be administratively closed also if the complainant no longer wishes to pursue their case. After the investigator reviews the complaint, she /he will issue one of two letters to the complainant: a closure letter or a letter of finding (LOF). A closure letter summarizes the allegations and states that there was not a Title VI violation and that the case will be closed. An LOF summarizes the allegations and the interviews regarding the alleged incident, and explains whether any disciplinary action, additional training of the staff member or other action will occur. If the complainant wishes to appeal the decision, she /he has 7 (seven) days after the date of the letter or the LOF to do so. A person may also file a complaint directly with the Federal Transit Administration, at FTA Office of Civil Rights, 1200 New Jersey Avenue SE, Washington, DC 20590. Office on Aping" * 61 Cooke Avenue ' CaNcrel, NJ 07008 Vfag Y�U ref001ui * Ar6T4FJ * 61 Z 4qf(5G * d2tif, A6. #. 07008 Tftulo VI procedimiento de reclamaci6n Toda persona que crea que ha sido discriminada en base a raza, color o origen nacional por el municipio de Carteret (en adelante "la autoridad ") puede presentar una queja por el titulo VI completando y enviando el titulo VI de la Agencia Formulario de reclamaci6n. La c►udad de Carteret investiga quejas recibidas no ma's de 180 dias despu6s del incidente alegado. La autoridad procesar6 las quejas que se completen. Una vez recibida la queja, la autoridad to revisara' para determinar si nuestra oficina tiene jurisdiccio'n. El demandante recibir6 una carta de acuse de recibo que le informar6 si la queja ser6 investigada por nuestra oficina. La autoridad tiene (7) siete dias para investigar la queja. Si se necesita m6s informac ►6n para resolver el caso, la autoridad puede ponerse en contacto con el demandante. El querellante tiene (7) siete dias h6biles a partir de la fecha de la carta para enviar la informac ►6n solicitada al investigador asignado al caso. Si el investigador no es contactado por el demandante o no recibe la informaci6n adicional dentro de (7) siete dias h6biles, la autoridad puede cerrar administrativamente el caso. Un caso se puede cerrar administrativo tambi6n si el querellante no desea continuar su caso. Despu6s de que el investigador revisa la queja, emitir6 una de dos cartas al querellante: una carta de clausura o una carta de hallazgo (LOF). Una carta de clausura resume las alegac ►ones y declara que no habfa una violaci6n del titulo VI y que el caso se cerrarfa. Un lof resume las alegaciones y las entrevistas con respecto al incidente alegado, y explica si cualqu►er acci6n disciplinaria, formaci6n adicional del m►embro del personal u otra acci6n ocurrir6. Si el demandante desea apelar la decisi6n, tiene 7 (siete) dias despues de la fecha de la carta o el Lof para hacerlo. Una persona tambi6n puede presentar una queja directamente con la administrac ►6n federal de tr6nsito, en la oficina de TLC de derechos civiles, 1200 New Jersey Avenue se, Washington, DC 20590. Office on Aging * Transporte Senior * 61 Cooke Avenue * Carteret, N107008 UTTC-,F vi fR4,(f 3W (Ep r f€d "Wq-3 " VA 7f€4F FFel ;a) zg f MU tY t, trl* i� tU814 t 3a6 ll� FT aas ?75 fEa z ftf 8 vi fRa, rma zaR as Rath t. 9 fq-V Ea a-ax adz i� �T4 �5 Fre tt fa fRW fe3' t 180 fee 14q ?d la? fAa. ��* a ua , fea �a faa� fa3 � 13 � � �, nra�azT f�a fsa� aas t�T Frx?fa�� ate? fa R' � za3a � ntf�a �3a t ;a. fAarfe3ad3 zs f�a »rte fasT fi r�3arT art zs ? fa fAa f�a e? a R3� 8838 a T. fNaf�3c daasFSEThl (7)F73ftt6ArAI-PH,tLJOV`98FlftVt� roc rTdyd3cal3�f�i�d2� f�arf�aa� �s �raa as FrazT �. fRa�e3aa3< �s (7) faa1 e? 3raltr � a3 aka? ft�s ar � xrx�Tr3 �a3< �nrar fi�fe3 z? Rx1fan� aar � ate, � / � fRa�(e3aa� � � �aa' � faa a� aria?: f�aaeaasa�s *uaa��feaLi3a(r�§ »�). f�aaaaar�Li3af€a�z�FFa��r3f�a� c� fa <-Tq <- 3 VI qt U4 7: ' c RT � tU -4R Afe UOUF. fEa LOF aft3 uFe?>, i� *tq f€d i�T KEI iEfdit9O 4tdi. #aa fF.Ld'fE:3a33 tTZ� di »019 crUff Ur#el t, 3' (tR at3 / QR i i fP43 ci fdt 9 7 (A3) f0Z5 VN-e aas 8? ;a. .■ •• • •• »lfdR r�U WOOUT * A?Nrd zai4aZ� . 61 a-4 » * aadz, 46. irt 07008 Record of Title A Complaints, Investigations & Lawsuits All subrecipients shall prepare and maintain a list of any of the following that allege discrimination on the basis of race, color, or national origin: • Active investigations conducted by FTA and entities other than FTA; • Lawsuits; and • Complaints naming the subrecipient. This list shall include the date that the transit - related Title VI investigation, lawsuit, or complaint was filed; a summary of the allegation(s); the status of the Investigation, lawsuit, or complaint; and actions taken by the recipient in response, or final findings related to the investigation, lawsuit, or complaint. List of Transit - Related Title VI investigations. Complaints, and Lawsuits Date (Month, Day, Year) Summary (Include basis of complaint; race, color, or national origin) status < Action(s) Taken Investigations N/A 1. 2. Lawsuits N/A 1. 2. Complaints N/A 1. 2. Title VI Complaint Form Note: The following information is needed to assist in processing your complaint. A. Complainant's information: Date: UTUM Address: City /State /Zip Code: Telephone Number (Home): Telephone Number (Work): Email Address: Accessible Format Requirements? (Select One or More) o Large Print o TDD o Audio Tape o Other B. Person discriminated against (if someone other than complainant): Name: Address: City /State /Zip Code: Telephone Number (Home): Telephone Number (Work): Email Address: Relationship to the person for whom you are complaining: Please explain why you have filed for a third party: Please confirm that you have obtained the permission of the aggrieved party if you are filing on behalf of a third party. o Yes o No C. Which of the following best describes the reason you believe the discrimination took place? Race Color National Origin Other: D. On what dates) did the alleged discrimination take place? Date: Date: Date: Date: Date: Other: E. Please describe the alleged discrimination. Explain what happened and whom you believe was responsible. Describe all persons who were involved. Include the name and contact information of the person(s) who discriminated against you (if known) as well as names and contact information of any witnesses. If additional space is needed, add a sheet of paper. F. Have you filed this complaint with any other Federal, State, or local agency, or with any Federal or State court? List all that apply. Federal Agency Federal Court State Agency State Court Local Agency If you have checked above, please provide information about a contact person at the agency /court where the complaint was filed. Name: Title: Address: City /State /Zip Code: Telephone Number (Home): Telephone Number (Work): Email Address: G. Please sign below. You may attach any written materials or other information that you think is relevant to your complaint. Signature Attachments: Yes H. Submit form and any additional information to: Carteret Office On Aging 61 Cooke Avenue Carteret, New Jersey 07008 Attention: Senior Transportation Date Titulo VI Formularlo de Queja Nota: La siguiente informaci6n es necesaria para ayudar en la tramitaci6n de su queja. Informaci6n de A. Denunciante: Fecha: Nombre: Direcci6n: Ciudad / Estado / C6digo Postal: N6mero de tel6fono (Inicio): _ N6mero de Tel6fono (Trabajo): _ Direcci6n De Correo Electr6nico: Requisitos formato accesible7 (Seleccione una o mas) • la ampliaci6n de foto • TDD • cinta de audio • Otros B. persona discriminada (si alguien que no sea quereilante): Nombre: Direcci6n: Ciudad / Estado / C6digo Postal: N6mero de tel6fono (Inicio): _ N6mero de Tel6fono (Trabajo): _ Direcci6n De Correo Electr6nico: Relaci6n con la persona a la que se quejan: Por favor, explique por qu6 usted ha presentado para un tercero: Por favor, confirma que ha obtenido el permiso de la parte perjudicada, si usted est6 presentando en nombre de un tercero. • Sf • No C. ZCufil de las siguientes opciones describe mejor la raz6n por la que cree que se produjo la discriminaci6n? _Race _Color _National Origen Otros: D. ZEn que fecha (s) ocurri6 la supuesta discriminaci6n ocurri6? Fecha: Fecha: Fecha: Fecha: Fecha: E. Por favor, describa la supuesta discriminaci6n. Explique to que pas6 y quien considera que fue responsable. Describir todas las personas que estuvieron involucradas. Incluya el nombre y la informaci6n de contacto de la persona (s) que to discrimin6 (si se conoce), asi como los nombres y la informaci6n de los testigos en contacto. Si necesita espacio adicional, agregue una hoja de papei. F. ZHa presentado esta queja ante cualquier otro, estatal o agencia local Federal, o con cualquier corte federal o estatal? Listar todos los que aplican. Federal Agency Tribunal Federal Agencia Estatal Tribunal Estatal Agencia Local Si ha comprobado anteriormente, proporcione informaci6n acerca de una persona de contacto en la agencia / tribunal donde se present6 la denuncia. Nombre: Titulo: Direcci6n: Ciudad / Estado / C6digo Postal: Numero de telefono (Inicio): _ Numero de telbfono (Inicio): _ Numero de Telefono (Trabajo): Direcci6n De Correo G. For favor firme abajo. Puede adjuntar cualquier material escrito o cualquier otra informaci6n que usted piensa que es relevante para su queja. Firma Adjuntos: Si No Fecha H. Envie el formulario y cualquier informaci6n adicional a: INSERT APROPIADO informaci6n de contacto aqui: Carteret Office Envejecimiento 100 Cooke Avenue Carteret, Nueva Jersey 07008 Atenci6n: Transporte Senior l • ' v P i �. e o F %T(5r: %Ff r c j c� 8t: uTut r"3*z�-vd c 8t 7i ,ju / fir / t#T4 a: h t5$d (Wu): Ir a€ rear z � df W ilt 4q ag) O Eon 9'4 O t.t.t. YA 1 t4 o c�a 25w: Ogg Rfaa / a-q / fau �: tt�T taa (uua): s tau (ax): far � qa4 i�g f6 r: a?t fzra Z3t faq zta a13, ;a: AVRI out urrv? Big fa�5* u' t�rg 'loot tT nrh >rthpin Wit tA- 4'tf4fttfl?f�uzL � lEr�aaat;� O Q O c.0s earl f€ Ann. auIrP-1 am011111 -4A yditsobSO rMiril D. faa S-&t4 (art) 't ofs3 ft-;3� �5 WM fez fKA fkft fkt: fKA MR: 00: faaF 004 afka f€.gat z< wayis A pool? fa Z# Ann off nif faFr m� Pra te-�aT3�a(i4 ti. 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