DHS Civil Rights Evaluation Tool

Documents and Forms

Document Name Document Type
1601—0024 DHS Civil Rights Evaluation Tool.pptx dhs.gov/resources-recipients-dhs-financial-assistance Other-Screenshots of portal
DHS Form 3095 Civil Rights Evaluation Tool DHS Form 3095 Civil Rights Evaluation Tool 508 Accessible with UEI.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DHS Civil Rights Evaluation Tool	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 6 CFR Parts 17, 19, 21 44 CFR Parts 7, 19 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Screenshots of portal			1601—0024 DHS Civil Rights Evaluation Tool.pptx	http://dhs.gov/resources-recipients-dhs-financial-assistance	Yes	Yes	Fillable Fileable
Form and Instruction	DHS Form 3095	Civil Rights Evaluation Tool	DHS Form 3095 Civil Rights Evaluation Tool 508 Accessible with UEI.pdf		Yes	Yes	Fillable Fileable

Line of Business: Homeland Security

Subfunction: Key Asset and Critical Infrastructure Protection

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,350	1,388	1,962
Annual IC Time Burden (Hours)	10,050	4,164	5,886
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.