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HEARING AND/OR SPEECH IMPAIRED MONTHLY SURCHARGE REMITTANCE FORM For ALEC, ALEC, WIRELESS AND ALL TELECOMMUNICATION COMPANIES THAT PROVIDE LOCAL ACCESS Intercompany Or Carrier Name: Utah Business
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Gather all the necessary information such as personal details and medical history.
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Determine which type of form is needed to be filled out for hearing and/or speech impaired individuals.
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Provide accommodations such as large print, Braille, or a sign language interpreter if required.
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Use clear and concise language while filling out the form to ensure understanding.
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Take time to communicate effectively and listen attentively to the individual's needs.
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Offer alternative methods of communication if necessary, such as using assistive devices or writing down responses.
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Who needs hearing andor speech impaired?

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Individuals who are hearing impaired and/or speech impaired may need assistance in filling out forms or communicating their needs.
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This includes individuals who have hearing loss, deafness, muteness, speech disorders, or any condition that affects their ability to hear or speak.
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People of all ages, from children to older adults, can be hearing and/or speech impaired and may require accommodations or support when dealing with paperwork or communication.
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Hearing and speech impaired refers to individuals who have difficulty hearing or speaking, or both.
Individuals who are hearing or speech impaired themselves, or individuals acting on behalf of someone who is hearing or speech impaired, are required to file.
The hearing and speech impaired form can be filled out by providing relevant information about the individual's impairment and any accommodations or assistance needed.
The purpose of filing a hearing and speech impaired form is to inform others about the individual's condition and make sure that any necessary accommodations or assistance are provided.
Information such as the nature of the impairment, any specific needs or accommodations required, and contact information for the individual or their representative must be reported.
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