DHS Civil Rights Compliance Form

ICR 202103-1601-002

OMB: 1601-0024

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2021-03-16
Supplementary Document
2021-03-09
Supplementary Document
2021-03-09
Supplementary Document
2021-03-09
Supplementary Document
2016-11-28
Supplementary Document
2016-11-28
Supplementary Document
2016-11-28
Supplementary Document
2016-11-28
Supplementary Document
2016-11-28
Supplementary Document
2016-11-28
Supplementary Document
2016-11-28
Supplementary Document
2016-11-28
Supplementary Document
2016-11-28
IC Document Collections
IC ID
Document
Title
Status
224608 Modified
ICR Details
1601-0024 202103-1601-002
Received in OIRA 201801-1601-001
DHS/OS
DHS Civil Rights Compliance Form
Reinstatement without change of a previously approved collection   No
Regular 03/16/2021
  Requested Previously Approved
36 Months From Approved
1,962 0
5,886 0
0 0

DHS has an obligation to enforce nondiscrimination requirements to ensure that its federally assisted programs and activities are administered in a nondiscriminatory manner. In order to carry out its enforcement responsibilities, DHS must obtain a signed assurance of compliance and collect and review information from recipients to ascertain their compliance with applicable requirements. DHS implementing regulations and the Department of Justice (DOJ) regulation Coordination of Non-discrimination in Federally Assisted Program, 28 C.F.R. Part 42, provide for the collection of data and information from recipients (see 28 C.F.R. 42.406). DHS uses DHS Form 3095: DHS Civil Rights Evaluation Tool as the primary tool to implement this information collection. The purpose of the information collection is to advise recipients of their civil rights obligations; obtain an assurance of compliance from each recipient, and collect pertinent civil rights information to ascertain if the recipient has in place adequate policies and procedures to achieve compliance, and to determine what, if any, further action may be needed to ensure the recipient is in compliance and will carry out its programs and activities in a nondiscriminatory manner.

US Code: 29 USC 794 Name of Law: Section 504 of the Rehabilitation Act of 1973
   US Code: 42 USC 2000d-1 Name of Law: Civil Rights Act of 1964
   US Code: 42 USC 6101 Name of Law: Age Discrimination Act of 1975
   US Code: 20 USC 1681 Name of Law: Title IX of the Education Amendments of 1972
  
None

Not associated with rulemaking

  85 FR 73731 11/19/2020
86 FR 12492 03/03/2021
No

1
IC Title Form No. Form Name
DHS Civil Rights Compliance Form 3095 DHS Form 3095 DHS Civil Rights Compliance Form

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1,962 0 0 0 -258 2,220
Annual Time Burden (Hours) 5,886 0 0 0 -774 6,660
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
DHS is not proposing any changes to the information collected in the form but is proposing changes to Section 1 of the form's instructions and Section 2 of the form to streamline and clarify the process for submitting the completed form. The form's changes to Section 1 and 2 do not impact the burden analysis. The burden has decreased from the previous reporting period (from 3331 to 2929 total respondents, or 2220 to 1962 annualized number of responses). Additionally, to clearly present information on annualized burden, DHS adjusted the method for calculating burden. DHS calculated burden based on the total number of respondents (2929) and annualized the number of responses per respondent (.67), whereas in the previous reporting period DHS calculated burden based on the number of responses (2220) assuming 1 response annually per respondent. These different calculation methods produce the same results but present the information differently.

$229,797
No
    No
    No
No
No
No
No
Tyrone Huff 202 447-0106 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/16/2021


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