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APPENDIX A--SURVEY QUESTIONNAIRE SURVEY QUESTIONNAIRE Transportation Cooperative Research Program Study Topic 11-03, Limited English Proficiency (LEP) Compliance Part I 1. Contact Information: Agency Name Location Respondent's Name Respondents' email Phone 2. Estimated LEP population in agency service area: Number of LEP persons _________ Percentage of LEP out of total population __________ Basis for LEP population estimate (Please check all that apply) Survey of transit patrons Input from community organizations Census data Data from state and local governments School system data 3. Does your agency have a written compliance program? Yes No 4. Has your agency received or been the subject of any complaints of any kind regarding LEP compliance or environmental justice based on treatment of LEP populations? Yes No 5. Has your agency received any objections to providing multilingual trip information? Yes No 6. LEP guidance: (Please check all that apply) Executive Order (EO) 13166 (Improving Access to Services for Persons with Limited English Profi- ciency)? Aware Relied on in designing agency's language activities DOT guidance on LEP compliance (DOT LEP Guidance, Federal Register, vol. 70, no. 239, pp. 7408774100, December 14, 2005)? Aware Relied on in designing agency's language activities FTA's guidance on LEP compliance (Chapter IV, part 4 of Circular 4702.1A, Title VI and Title VI- Dependent Guidelines for FTA Recipients)? Aware Relied on in designing agency's language activities State or local requirements for providing language access to LEP populations in your service area? Aware Relied on in designing agency's language activities DOT Order 5610.2, U.S. DOT Order on Environmental Justice to Address Environmental Justice in Minority Populations and Low-Income Populations? Aware Relied on in engaging in LEP outreach 7. Would a report examining legal issues related to LEP compliance be useful to your agency? Yes No Are there any specific legal issues that you think should be addressed? Yes No If you answered Yes to questions 4 or 5, please complete Part II. Part II 8. Compliance: (Please check any compliance issues with which your agency has been involved) LEP deficiencies documented by FTA Administrative action related to LEP compliance LEP issues with employees Litigation related to LEP compliance Suspension of federal funding due to LEP Actions related to environmental justice noncompliance 17