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OMB Control No: 1601-0024	ICR Reference No: 202103-1601-002
Status: Historical Active	Previous ICR Reference No: 201801-1601-001
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: DHS Civil Rights Compliance Form
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/11/2021
	Date Received in OIRA: 03/16/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved
Responses	1,962	0	0
Time Burden (Hours)	5,886	0	0
Cost Burden (Dollars)	0	0	0

Abstract: 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.

Authorizing Statute(s): 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

Citations for New Statutory Requirements: None

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 73731	11/19/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 12492	03/03/2021
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

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

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,962	-258	2,220
Annual Time Burden (Hours)	5,886	-774	6,660
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: 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.

Annual Cost to Federal Government: $229,797

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Tyrone Huff 202 447-0106 tyrone.huff@associates.dhs.gov

View ICR - OIRA Conclusion