Form ATF F 2931.1 ATF F 2931.1 Race and Ethnicity Identification

U.S. Department of Justice
Bureau of Alcohol, Tobacco, Firearms and Explosives

OMB No. 1140-0047 (xx/xx/xxxx)

Race and Ethnicity Identification

(Please read the instructions and Privacy Act Statement before completing form.)
Agency Use Only
Name (Last, first, middle initial)
Birthdate (Month and year)

Social Security Number:

Gender:

Male

Female

Ethnicity
Hispanic or Latino

A person of Cuban, Mexican, Puerto Rican, Central or South
American or other Spanish culture or origin, regardless of race.

Not Hispanic or Latino
Racial Identification
(Mark ONE or more)
American Indian or Alaska Native

Definition of Racial Identification/Category

A person having origins in any of the original peoples of North and South America (including
Central America), and who maintains tribal affiliation or community attachment.

Asian

A person having origins in any of the original peoples of the Far East, Southeast Asia, the
Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand and Vietnam.

Black or African American

A person having origins in any of the black racial groups of Africa.

Native Hawaiian or Other Pacific
Islander

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other
Pacific Islands.

White

A person having origins in any of the original peoples of Europe, the Middle East, or North
Africa.
Privacy Act Information

You are requested to furnish this information under the authority of 42 U.S.C. §2000e-16 which requires that Federal employment practices be free
from discrimination and provide equal employment opportunities for all. Solicitation of this information is in accordance with OMB Statistical Policy
Directive 15, “RACE AND ETHNIC STANDARDS FOR FEDERAL STATISTICS AND ADMINISTRATIVE REPORTING.”
This information will be used in planning and monitoring equal employment opportunity programs and to identify employees for inclusion in skill
banks and referral pools.
Your furnishing this information is voluntary. Your failure to do so will have no effect on you or on your Federal employment. If you fail to provide
this information, however, then the employing agency will attempt to identify your race and ethnicity by visual perception.
You are requested to furnish your Social Security Number (SSN) under the authority of Executive Order 9397 (November 22, 1943). That Order
requires agencies to use the SSN for the sake of economy and orderly administration in the maintenance of personnel records. Because your personnel
records are identified by your SSN, your SSN is being requested on this form so that the other information you furnish on this form can be accurately
included with your records. Your SSN will be used solely for that purpose. Your furnishing of your SSN is voluntary and failure to furnish it will have
no effect on you; failure to provide it, however, may result in it being obtained from other agency sources.
Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used to maintain Race and Ethnicity Identification
data on all employees and new hires to meet diversity/EEO goals and as a component of a tracking system to ensure that personnel practices meet the
requirements of Federal law. The information requested is voluntary.
The estimated average burden associated with this collection of information is 3 minutes per respondent or recordkeeper, depending on individual
circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to Reports
Management Officer, Document Services, Bureau of Alcohol, Tobacco, Firearms and Explosives, Washington, DC 20226.
An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB
control number.
ATF Form 2931.1
Revised (
)