Language Capability Attestation (Disclosure) Form

In Accordance with, Section 1300.67.04 of the Language Assistance Program Regulations, Holman needs to identify within its provider network those contracted providers who are themselves bilingual or who employ other bilingual providers and/or office staff, based on language capability attestation forms signed by the bilingual providers and/or office staff, attesting to their fluency in languages other than English.

* Required Field