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OMB Control No: 1601-0024	ICR Reference No: 202406-1601-001
Status: Active	Previous ICR Reference No: 202301-1601-001
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: DHS Civil Rights Evaluation Tool
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/21/2024
	Date Received in OIRA: 06/24/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2027	36 Months From Approved	11/30/2024
Responses	3,350	0	1,962
Time Burden (Hours)	10,050	0	5,886
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 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
   US Code: 42 USC 2000d-1 Name of Law: Civil Rights Act of 1964

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:
	89 FR 8692	02/08/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 51545	06/18/2024
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 Evaluation Tool	DHS Form 3095

ICR Summary of Burden

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

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: DHS is seeking a revision of the form for another three-year period. DHS is proposing changes to Section 1 of the form on Instructions to extend the deadline for initial submissions from 30 days of receipt of the Notice of Award to 60 days; to update the method of submission from email to an online portal; and to make other minor clarifying revisions. DHS also proposes minor changes to Section 2 of the form on Organization Information to remove the fields for reporting Grant Agreement Number and Federal Award Identification Number as DHS now obtains that information from Department data sources. DHS also proposes minor changes to Section 5 of the form on Additional Information to streamline communication with recipients by providing a single, centralized point of contact for questions and technical assistance. Lastly, DHS is changing the name of the collection from ‘‘DHS Civil Rights Compliance Form’’ to ‘‘DHS Civil Rights Evaluation Tool.’’ The changes to Section 1, 2, and 5 do not impact the burden analysis. The changes in burden in Items 12 and 14 reflect the increase in the number of entities that are required to respond to the collection (as a result of increased Department grantmaking) increase in hourly wage rates as reported by BLS in the 2022 National Occupational Employment and Wage Estimates, increase in hourly wage rates for Federal staff as reported by Office of Personnel Management for 2023, increases in the number of staff supporting the program, and development of an online portal to streamline and modernize the submission process.

Annual Cost to Federal Government: $1,769,227

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: Christina Walsh 571 227-2062 christina.walsh@tsa.dhs.gov

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