Required Form - SCD 1264

The language designation on the “Language Survey - Interpreter/ Translation Request” (SCD 1264) form must be selected by the client to meet Federal Law and Civil Rights Mandates. The SCD 1264 is available in 27 different languages, and staff needs to use the form that corresponds to the language the client identifies. SSA should assist the visitor and answer any questions about the form, but the language identification must be selected by the client. The information from the SCD 1264 is used to input the client’s primary language into the CalWIN Data Collection System. Refer to Translated Forms, Large Print Font, Braille for language listing. As part of Chapter 21 State Compliance, the case record needs to identify the applicant/recipient’s primary language. Chapter 21 also requires that the case record identify the ethnic origin of the applicant/recipient.

The SCD 1264 is required at:

  • Intake
    • At each application.
  • Continuing
    • When there is no SCD 1264 on file,
    • Whenever the caretaker/relative changes,
    • When the client requests a change, and
    • At Redetermination/Recertification.

Note: The county may not complete the form on behalf of the client, unless the client is unable to write because of illiteracy or disability.

Processing the SCD 1264

The SCD 1264 is to be thoroughly completed. The client completes the form at the initial Benefits Intake appointment by selecting his or her preferred spoken and written language, and also indicating his or her native language. Client is to select the type of interpreter services, if needed, date and sign form. SSA staff is to complete the county use only section of form. The Eligibility Worker is responsible for processing the SCD 1264 with the client in continuing. When processing the SCD 1264, the EW in continuing or Clerical at Intake must:

  • Determine the primary oral and written language of the client by speaking with client, or through client pointing to his or her language using the “We Speak Your Language” (SCD 2334) form.
  • Print the appropriate language version of the SCD 1264 from the DEBS Form’s Library.
  • Ensure that the client selects his or her primary language and interpreter services needs, signs and dates form.
  • Complete the county use only section in front of client.
  • From the CalWIN language drop-down list, ensure the language matches the client’s selected language from the SCD 1264.
  • Submit SCD 1264 to clerical for scanning form into the IDM system under F1 - Application.

Other Language Services

Determine if other language services are required:

  • What type of language services does the applicant/recipient require (i.e., bilingual staff, interpreter, use of own interpreter family member, or friend, translated materials, etc.). Refer to Client's Own Interpreter Arrives because the use of 3rd party interpreters should be discouraged.
  • Complete and check appropriate boxes of “Interpreter Services Statement and Confidentiality Agreement” (CR 6181).
  • Sign and date the CR 6181 form with the client and interpreter, if an interpreter is used.

Method in Which Interpreter Services Provided

The method in which interpreter services is provided to the client must be thoroughly documented in Case Comments, whether the services were provided such as: via assigned certified bilingual worker, other bilingual employee acted as interpreter, interpreter services provided via Voiance Interpreter Services, in-house bilingual contractor, a volunteer interpreter was used, or individual provided their own interpreter.”

Example: Visitor identifies Burmese as his language of preference on the SCD 2334 and no on-site interpreter is available.

Case Comment: “Visitor’s language of preference was identified via ‘We Speak Your Language’ (SCD 2334) and staff utilized Voiance Interpreter Services to provide interpreter services with client in Burmese.”

When the client has a unique language need such as, understands oral Vietnamese, but is not be able to read it (written) and does not understand English, the case is coded Vietnamese with a case comment documenting that client does not read Vietnamese and does not understand English but understand Vietnamese (oral). The client correspondence would be issued in Vietnamese but the bilingual worker is required to explain the Vietnamese form to client.

Mail-In Process

When the application or re-application is completed via the mail-in process or by another entity, and the “Language Survey” (SCD 1264) is not included with the paperwork, the EW must:

  • Review any other documents to determine the client’s primary oral and written language.
  • Contact client to confirm language and inform him or her that the SCD 1264 is being mailed for client to select language preference, and to select type of interpreter services, if needed. Inform client that form is being mailed along with returned envelope for returning to county within 10 working days.
  • Complete and check appropriate boxes of “Interpreter Services Statement and Confidentiality Agreement” (CR 6181), if client prefers to use his/her own interpreter.
  • Discuss the CR 6181 with client. If client prefers his or her own interpreter, complete and sign the County Use Section.
  • Forward/mail the SCD 1264 to the client along with returned envelope.
  • Once the SCD 1264 is completed by client and signed by the EW, submit form to clerical to be scanned into IDM.
  • Document Maintain Case Comments in CalWIN indicating the client’s preferred oral and written language upon receipt of SCD 1264.
  • If client does not return SCD 1264, enter case comments in CalWIN, explaining that form was mailed but not received; and document how the language was identified, such as the language designation on SAWS 2 Plus.

Note: The case may be transferred out of intake and/or continuing pending the return of the original SCD 1264.

Reminder: For each case file, there must be an SCD 1264 properly completed by client. And if client prefers to provide his or her own interpreter, a CR 6181 must be throughly completed and in IDM. Case comments need to reflect the method in which interpreter services were provided to client in his or her preferred language. For example, if assigned bilingual worker provided interpreter services, then CalWIN case comment narration needs to indicate,” Assigned Certified bilingual Spanish speaking worker provided interpreter services in Spanish to Spanish speaking client.”

Related Topics

Interpreter Services

Translation Requests by DEBS Staff