DHS Civil Rights Compliance Form

OMB 1601-0024

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.

The latest form for DHS Civil Rights Compliance Form expires 2021-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DHS Form 3095 DHS Civil Rights Compliance Form 3095 Form and Instruction
OMB Form 83-C for DHS Form 3095.pdf Justification for No Material/Nonsubstantive Change
1601-0024_Supporting Statement A for Renewal DHS Form 3095.docx Supporting Statement A
Narrative of Changes Table - DHS Civil Rights Evaluation Tool Updated 2.16.2021.docx Supplementary Document
42 USC 6101.pdf Supplementary Document
42 USC 2000d-1.pdf Supplementary Document
29 USC 794.pdf Supplementary Document
28 CFR Part 42.docx Supplementary Document
20 USC 1681.pdf Supplementary Document
44 CFR Part 19.pdf Supplementary Document
44 CFR Part 7.pdf Supplementary Document
6 CFR Part 21.pdf Supplementary Document
6 CFR Part 17.pdf Supplementary Document
DHS Civil Rights Compliance Form 3095 Form and Instruction

All Historical Document Collections

202301-1601-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-01-11
202103-1601-002 Approved without change	Reinstatement without change of a previously approved collection	2021-03-16
201801-1601-001 Approved with change	New collection (Request for a new OMB Control Number)	2018-01-30
201611-1601-001 Withdrawn	New collection (Request for a new OMB Control Number)	2016-12-19

OMB Details

DHS Civil Rights Compliance Form

Federal Enterprise Architecture: Homeland Security - Key Asset and Critical Infrastructure Protection

Form DHS Form 3095

DHS Civil Rights Compliance Form

dhs.gov/resources-recipients-dhs-financial-assistance

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.