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DPSS ePolicy

This release provides additional guidance and instructions for completion of the CR 6181, including guidelines for customers who choose their own interpreter instead of free interpretive services from DPSS.

[CalFresh,CalWORKs,CAPI,Child Care,GAIN,GR,IHSS,Medi-Cal,Customer Service Center,START], CR 6181, Interpreter Services Statement and Confidentiality Agreement, 03-25-2025

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CIVIL RIGHTS

CR 6181, Interpreter Services Statement and Confidentiality Agreement

Release Date
03/20/2025

Section Heading

Purpose

To revise an existing policy and/or form(s).

 What changed?

  1. Added guidance on using the CR 6181 form, Interpreter Services Statement and Confidentiality Agreement (11/20), when Deaf and Hard of Hearing (DHH) customers use their own interpreter.
  2. Added reference to Video Remote Interpreter (VRI) Services.
  3. Added instructions for completing the CR 6181 form during remote service delivery.
  4. Clarified the policy on using the CR 6181 form for Telecommunication Relay Services (TRS).

Policy

The CR 6181, Interpreter Services Statement and Confidentially Agreement (11/2020) is used to:

  1. Inform Limited English Proficient (LEP) and DHH customers of the risks of using their own interpreter, instead of utilizing the free interpretive services provided by the Department of Public Social Services (DPSS).  This includes potential communication errors and the importance of maintaining confidentiality of sensitive and personal information that is shared during the interpretation process. 
  2. Document language services requirements when customers use their own interpreter.
  3. Document the customer’s own interpreter confidentiality agreement; and
  4. Reaffirm LEP and DHH customers' right to request free interpretive services from DPSS.

Impact

CalWORKs, Refugee Cash Assistance (RCA), GAIN, General Relief, START, CalFresh, Medi-Cal, IHSS, CAPI, Human Resources, and District Operations

Available Through

Forms Library, Warehouse Logistics Asset Management Section (WLAMS), California Statewide Automated Welfare System (CalSAWS) Template Repository, Case Management, Information and Payrolling System (CMIPS) Electronic Forms.

Languages

English, Spanish, Armenian, Cambodian, Chinese, Farsi, Korean, Russian, Tagalog, Vietnamese

Note: When a form is needed in a language for which a translation is not available, provide the English version, along with the GEN 1365, Notice of Language Services; verbally translate the form; and document the case record per existing procedures.  The CR 6181 form does not replace the GEN 1365 Notice of Language Services.

Ordering Instructions

Order supplies from WLAMS via a PA 16 Supply Requisition. An initial supply will be distributed in all threshold languages to all DPSS offices.

Current Inventory

Should be recycled per procedures contained in the DPSS Operations Handbook, Section 23-600.

Background

On October 17, 2024, the California Department of Social Services released All County Letter 24-68, which provides updated instructions for using the CR 6181 form.  These revised instructions offer guidance on supporting DHH individuals who wish to use their own interpreter.  The instructions also cover how to complete the CR 6181 form during remote service delivery and include reminders about using TRS.

Definitions

N/A

Requirements

This form must be used when customers choose to use their own interpreter after they have been offered free County-provided language interpretive services.  Free DPSS language interpretive services include:

  1. Verbal interpretation by departmental certified bilingual staff;
  2. Telephone interpretive services by a contracted language service vendor;
  3. American Sign Language (ASL) and Spanish Sign Language (SSL) interpretation by an ASL/SSL certified vendor; and
  4. VRI services.

Verification Docs

N/A

Attachments

CR 6181, Interpreter Services Statement and Confidentiality Agreement

Index

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Glossary

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APP
Pre Apprenticeship Certificate Program
AU
Administratively Unemployable
CLA
Clinical Assessment Appointment
CLE
Clinical Engagement
CORE
Career, Opportunities, Resources and Employment
CSS
Department Of Community And Senior Services
CSSD
Child Support Services Department
DMH
Department Of Mental Health
EJS
Early Job Search
ELAAJCC
East Los Angeles America’s Job Center Of California
ES-EW
Employment Special Eligibility Worker
HiSEC
High School Equivalency Certificate
HiSET
High School Equivalency Test
JOC
Job Order Coordinator
JRT
Job Readiness Training
JSPC
Job Skills Preparation Class
LACOE
Los Angeles County Office of Education
LADOT
Los Angeles Department of Transportation
LOD
Line Operations Development
NSA
Need Special Assistance
PCC
Pasadena City College
REP
Rapid Employment Promotion
SIP
Self-Initiated Program
SOA
Security Officer Assessment
SOT
Security Officer Training
SSVF
Supportive Services for Veteran Families
TAP
Transit Access Pass
VA
Department of Veteran Affairs
VL
Veteran Liaison
WIOA
Workforce Innovation & Opportunity Act

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