Appendix A to Part 92
Notice Informing Individuals About Nondiscrimination and Accessibility Requirements/Nondiscrimination Statement: Discrimination is Against the Law
Trinity Management Services Organization, LLC. (“Trinity”) and the Healthy Living Network (“HL Network”) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Trinity and the HL Network does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Trinity and the HL Network
1. Provides free aids and services to people with disabilities to communicate effectively with us such as:
a. Qualified sign language interpreters
b. Written information in other formats (large print, audio, accessible electronic formats, other formats)
2. Provides free language services to people whose primary language is not English, such as:
a. Qualified interpreters
b. Information is written in other languages
If you need these services, please contact Brian Sherman, Civil Rights Coordinator at firstname.lastname@example.org
If you believe that Trinity or the HL Network 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:
Brian Sherman, Civil Rights Coordinator
3001 Douglas Blvd., Suite 225
Roseville, CA 95661
Telephone – 866-410-8599
Fax – 916-848-3771
Email – email@example.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Brian Sherman, Civil Rights Coordinator 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.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a su agencia local.