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Effective Communication for Persons Who Are Deaf or Hard of Hearing

What Laws Apply to Effective Communication for Persons Who Are Deaf or Hard of Hearing?

Section 504 of the Rehabilitation Act of 1973 (Section 504) forbids public and private entities that receive financial assistance from any Federal department or agency from excluding qualified individuals with disabilities or denying them an equal opportunity to receive program benefits and services.  These organizations are the recipients, or covered entities.  The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has Section 504 authority over covered entities that receive financial assistance from HHS, including many hospitals, nursing homes, mental health centers, and human service programs.  OCR also has Section 504 authority over programs and activities conducted by HHS.

The Americans with Disabilities Act of 1990 (ADA) provides civil rights protections to individuals with disabilities in the areas of employment, state and local government services, public accommodations (most private offices and businesses), transportation, and telecommunications.  OCR at HHS has ADA Title II authority over state and local government health and human service agencies.

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Who Is Protected Under These Laws?

These laws protect qualified individuals with disabilities. An individual with a disability is a person who has a physical or mental impairment that substantially limits one or more major life activities (such as hearing, speaking, sleeping, thinking, learning, working or the operation of a major bodily function); has a record of such an impairment; or is regarded as having such an impairment.

For purposes of receiving services, education, or training, qualified individuals with disabilities are persons with disabilities who are eligible for the service, program, or activity.  An individual is qualified, if, with or without reasonable modifications, the person meets the essential eligibility requirements for the specific service, program, or activity.

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How Do These Laws Protect Individuals Who Are Deaf or Hard of Hearing?

Individuals who are deaf or hard of hearing are protected when they are qualified individuals with a disability under the ADA or Section 504.  For example:

  • A 40-year old person who is deaf would not be a qualified individual with a disability for a program limited to people over 65.
  • A 7-year old child who is hard of hearing would probably be a qualified individual with a disability for a vaccination program that is provided to all school-age children.

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What Do These Laws Say about Communication with People Who Are Deaf or Hard of Hearing? 

Covered entities must provide effective communication, by using auxiliary aids and services if needed to ensure effective communication when the provision of such aids or services does not result in a fundamental alteration (change in the basic nature of the service) or undue financial or administrative burden for the entity.  Effective communication with a qualified person who is deaf or hard of hearing is communication that allows the person an equal opportunity to participate in, and enjoy the benefits of, a service, program, or activity.  Auxiliary aids and services may include the following, depending on the needs of the individual in the particular situation:

  • qualified interpreters*,
  • note takers,
  • transcription services,
  • written materials,
  • telephone handset amplifiers,
  • assistive listening devices,
  • assistive listening systems,
  • telephones compatible with hearing aids closed caption decoders, open and closed captioning,
  • text telephones (TTYs)
  • videotext displays, or other effective methods of making aurally delivered** materials available to individuals who are deaf or hard of hearing.

*   “Qualified interpreter” means an interpreter who is able to interpret effectively, accurately, and impartially, both receptively and expressively, using any necessary specialized vocabulary.

**   “Aurally delivered information” means information that is delivered through sound, including through speech, intercoms, telephones, recorded messages, loudspeakers, alarms, etc.

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What Can You Do If You Need an Auxiliary Aid or Service? 

As soon as possible:

  • Let the entity know that you are deaf or hard of hearing and
  • Ask for the auxiliary aid or service you think you need (interpreter, notepaper, etc.).  

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Who Decides Whether and What Kind of Aid or Service Will Be Provided? 

The covered entity is responsible for ensuring that effective communication happens.  Generally, the entity should consult with the person who is deaf or hard of hearing about how to do this, and should give primary consideration to fulfilling that person’s request if one is made. 

The covered entity also needs to consider how many people are participating in the communication and their individual characteristics.  The covered entity should think about the particular situation or context and the nature, length, complexity and importance of the communication.  In a short and simple transaction, the covered entity’s staff can often communicate with individuals who are deaf or hard of hearing through facing the individual and speaking clearly, through written materials, gestures, and/or through exchanging written notes.  Sign language or oral interpreters may be necessary when the information being communicated is complex or is exchanged for a lengthy period of time.

If an auxiliary aid or service is needed, the entity must provide it free of cost to the qualified individual with a disability.  The entity may furnish an auxiliary aid or service that is different from the one requested if the entity can demonstrate that the alternative also provides for effective communication for the individual in the situation.  The entity does not have to provide a specific auxiliary aid or service if doing so will result in a fundamental alteration of the program or service or would result in an undue burden.  The decision that compliance would result in a fundamental alteration or undue burden must be made on a case-by-case basis, after considering all resources available for use in the funding and operation of the service, program, or activity.

  • A person who is deaf went to the doctor’s office to have a blood test.  The doctor knew that the visit would be very short and that there would be very little communication during the visit.  After consulting with the individual, the doctor determined that an interpreter was not needed, and that writing notes and gestures would be effective for this patient in this situation.  For the next appointment to discuss the results of the blood test and to talk about treatment decisions, the doctor provided an interpreter.  In making these decisions, the doctor consulted with the individual, thought about the needs of the individual, the circumstances, the importance, nature, and complexity of the communication, and whether providing an interpreter would constitute an undue burden under the law.

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What If You Do Not Agree That the Communication Is, Or Will Be, Effective?

You can tell the service provider if you think the communication is not, or will not be, effective.  You should tell the provider why you think it is not effective.  For example:

  • A deaf parent of a child in a Head Start program requested a meeting with the Director to talk about problems with her child’s teacher.  The Director asked a teacher who was a close friend of the child’s teacher to serve as an interpreter.  The parent told the Director that she thought an outside interpreter should be obtained because the interpreter might not be able to remain impartial.

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Who May File a Complaint with the Office for Civil Rights of the U.S. Department of Health and Human Services?

If you believe that you (or another person or a class of individuals) have been subjected to discrimination on the basis of a disability in a health or human service program or activity conducted by HHS, by an entity receiving Federal financial assistance from HHS, or by a state and local government health care or human service agency, you may file a complaint with OCR.  Complaints against other entities should be filed with the appropriate federal agency.  You may contact OCR for assistance in filing a complaint. Complaints must be filed within 180 days from the date of the alleged discrimination.  OCR may extend the 180-day deadline if you can show "good cause."

Include the following information in your written complaint, or request a Discrimination Complaint Form from an OCR Regional or Headquarters office (complaints must be signed by the complainant or an authorized representative):

  • Your name, address, and telephone number.
  • Name and address of the entity you believe discriminated against you.
  • How, why, and when you believe you were discriminated against.
  • Any other relevant information.

Complaints may be filed either on paper or electronically via the OCR Complaint Portal, by mail, fax, or e-mail.  You may send your complaint to the Regional Manager at the appropriate OCR Regional Office, or to the address below. Upon receipt, OCR will review the information provided. If we determine we do not have the authority to investigate your complaint, we will, if possible, refer it to an appropriate agency. Complaints alleging employment discrimination on the basis of disability against a single individual may be referred to the U. S. Equal Employment Opportunity Commission for processing.

Private individuals may also bring lawsuits against a public entity to enforce their rights under Title II of the ADA.

For Further Information, Contact:

Office for Civil Rights
U. S. Department of Health and Human Services
200 Independence Avenue, SW - Room 509-F
Washington, D.C. 20201
Hotlines: 1-800-368-1019 (Voice) | 1-800-537-7697 (TDD)
E-Mail:  | Website:

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