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Developing a Self-Assessment Toolfor Culturally - Office of Minority ...

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3. Please report or estimate what percentage <strong>of</strong> your clients falls into the following ethnic group.Record Percent Actual Estimateda. Hispanic or Latino ..............................% ~ ~If reporting the actual percentage, what is the source used for your response? ~ Don’t know4. Does your agency’s client information database record the primary language spoken by each client?~ Yes, for all clients ! go to 5~ Yes, for certain clients ! go to 5~ No ! go to 4a~ Don’t know ! go to 54a. To your knowledge, what are the reasons you do not record primary language spoken for yourclients?MARK ALL THAT APPLY~ Clients’ privacy rights~ Concerns about quality or completeness <strong>of</strong> data~ Concerns about legal liability~ Other, please specify _______________________________________~ Don’t know5. Approximately what percentage <strong>of</strong> your clients speak a primary language other than English?Actual EstimatedRecord Percentage% ~ ~If reporting the actual percentage, what is the source used for your response? ~ Don’t know6. In your agency’s data systems, can client demographic information (such as race/ethnicity andlanguage) be linked with other data (such as client satisfaction, grievances/complaints, anddis-enrollment)?~ Yes~ No~ Don’t knowCOSMOS Corporation, December 2003 6

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