5800-056 Diversity Profile Survey

OMB Control Number: 2003-New
Expiration Date: XX/XX/XXXX
Diversity Profile Questions
This collection of information is approved by OMB under the Paperwork Reduction Act, 44
U.S.C. 3501 et seq. (OMB Control No. 2003-NEW). Responses to this collection of information
are voluntary (33 U.S.C. 1267). 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. The public reporting and recordkeeping burden for this collection of
information is estimated to be 0.05 hours per response. Send comments on the Agency’s need
for this information, the accuracy of the provided burden estimates and any suggested
methods for minimizing respondent burden to the Regulatory Support Division Director, U.S.
Environmental Protection Agency (2821T), 1200 Pennsylvania Ave., NW, Washington, D.C.
20460. Include the OMB control number in any correspondence. Do not send the completed
form to this address.
1. What type of organization(s) do you currently work for? (choose all that apply)
• Local government
• State government
• Federal government
• Non-governmental organization
• Faith-based organization
• Private sector
• Other (please specify)
2. Within your organization, what is your role? Please choose one.
• Leadership/management
• Staff
• Volunteer
• Other (please specify)
3. Do you identify yourself as a member of Chesapeake Bay Program (CBP) leadership?
Please select all that apply.
• Principals’ Staff Committee member
• Management Board member
• Goal Team Chair/Co-Chair/Vice-Chair
• Workgroup Chair/Co-Chair/Vice-Chair
• Advisory Committee Chair/Co-Chair/Vice-Chair
• I was formerly one or more of the above options but currently do not
identify myself as a member of CBP leadership
• I do not identify myself as a member of CBP leadership

4. How long have you been participating in the CBP partnership? (select one)
• 0-5 years
• 6-10 years
• 11-20 years
• 21-30+ years
5. What is your gender? (choose all that apply)
• Male
• Female
• Non-binary
• Nonconforming
• Transgender
• None of the above (please specify)
• Decline to state
6. What is your age? (select one)
• 18-24
• 25-34
• 35-44
• 45-54
• 55-64
• 65-74
• 75 or older
• Decline to state
7. Which category(s) best describe you? (select all that apply).
• Asian
• Black or African American
• Hispanic or Latino/Latina/Latinx
• Middle Eastern or North African
• Mixed/Multi-racial (unspecified)
• Native American, American Indian, or Alaskan Native
• Native Hawaiian or Other Pacific Islander
• White
• None of the above (please specify)
• Decline to state
8. Do you identify as a member of the LGBTQIA+ community? (select one)
• Yes
• No
• Decline to state

9. Do you identify as a person who is disabled? (select one)
• Yes
• No
• Decline to state
10. What Chesapeake watershed jurisdiction do you live in?
• Delaware
• District of Columbia
• Maryland
• New York
• Pennsylvania
• Virginia
• West Virginia
• Outside of the Chesapeake Bay watershed (please specify)
11. In what type of developed environment (landscape) do you currently reside? (select
one)
• Urban
• Suburban
• Rural
• Other (please specify)
12. Please list all CBP groups that you regularly engage with (e.g., as a member or an
interested party). CBP groups include the Principals’ Staff Committee, Advisory
Committees, Management Board, STAR, Goal Implementation Teams, Workgroups,
and Action Teams.
(open-ended response)
13. Did you fill out this demographic profile when it was sent out in previous years?
(select one)
• Yes
• No
• I do not recall
EPA Form 5800-056

.