Form ATF F 2931.1 ATF F 2931.1 Race and National Origin Identification

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

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

Race and National Origin Identification

(Please read the instructions and Privacy Act Statement before completing form.)
Agency Use Only
Birth Date (Month and Year)
(First)
(Middle Initial)

Name (Last)

Specific Instructions
The categories below are designed to identify your basic racial and national origin category. If you are of mixed racial and/or national origin, identify
yourself by the category with which you most closely identify yourself.
Gender:

Social Security Number:
Name of Category
(Mark ONE or more)

Male

Female
Definition of Category

American Indian or Alaska Native

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.

Hispanic or Latino

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

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, not of Hispanic origin

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

Hispanic or Latino
Not Hispanic or Latino

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

ATF E-Form 2931.1
Revised May 2005

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 Department of Commerce
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 national origin 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 National Origin 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 Branch, 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 E-Form 2931.1
Revised May 2005