Form FS-1700-0006B Civil Rights Compliance Review Record -Federally Assiste

Civil Rights Compliance Review Record Federally Assisted Programs, Employee Interview
(Ref. FSH 1709.11) Internal Use Only

FS-1700-0006B (REV. 08/2012)
OMB 0596-0215 (EXP. 09/2015)

During a Post-award review, this form is to be used as a continuation of the Civil Rights Compliance Review Record for
recipients of Federal Financial Assistance. This section will record a response from an Employee of the Recipient only. It is
necessary for the Forest Service to separate the CR Compliance Review form to protect the privacy of any individuals who
agree to be interviewed during the post-award review. If the Recipient requests a copy of the full review record FS-1700-0006,
this employee response FS-1700-0006B will not be included.
Burden Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a valid OMB control number. Response to this information collection is voluntary. The valid OMB control number for this
information collection is 0596-0215. The time required to complete this information collection is estimated to average 5 minutes per response, including the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age,
disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal,
or because all or part of an individual's income is derived from any public assistance. (Not all prohibited bases apply to all programs.) Persons with
disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET
Center at 202-720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call toll
free (866) 632-9992 (voice). TDD users can contact USDA through local relay or the Federal relay at (800) 877-8339 (TDD) or (866) 377-8642 (relay
voice). USDA is an equal opportunity provider and employer.

PART I - POST-AWARD REVIEW INTERVIEW OF AN EMPLOYEE OF THE RECIPIENT
It is necessary for the Forest Service to separate the CR Compliance Review form to ensure the privacy of any individuals who
agree to be interviewed for the review. Form FS-1700-0006B serves as a post award review record for employee(s) of
recipients. The CR Review Forms A, B, C, will be kept with the Forest Service recipient's file. However, if the recipient
requests a copy of the review, the form FS-1700-0006B is not to be provided.
Yes

No

N/A
1. Have you been trained or informed of your responsibilities under civil rights laws
about nondiscrimination?
2. Have you received information on how to advise participants/customers on
filing a program discrimination complaint?

Name of Employee (Optional):
PART II - SUMMARIES
Use this section to provide more detail to the answers to specific questions.

Filecode: 1770

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FS-1700-0006B (REV. 08/2012)
OMB 0596-0215 (EXP. 09/2015)

INSTRUCTIONS
Part I - Additional Questions for Post-Award Reviews
Note: This section does not apply to applicants. Only complete during a Post-Award Review.
- When possible, schedule employee interviews in advance of the onsite post-award compliance review and conduct interviews
during the review of recipient's employees.
- Ask the questions and, as appropriate, and use Part II to record the employee interview responses.
Part II - Summaries for Post-Award Reviews
- Use this section to describe or explain the answers to the Part I. questions made by employees of the recipient, and to
summarize any deficiencies and/or barriers.
File the record along with FS-1700-0006A and FS-1700-0006C in the recipient's case file. If the Recipient requested a copy of
the full review record in FS-1700-0006, this employee response FS-1700-0006B will not be included.

Filecode: 1770

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