CIVIL RIGHTS COMPLIANCE PLAN TEMPLATE Children and Families DCF-F-155-E (R. 11/2017) Health Services F-00164 Workforce Development (R. 12/1/2013) Recipient Contact Information and Signature Page - APPENDIX A The same Recipient Contact Information and Signature Page previously completed for the CRC LOA should be used for the CRC Plan. Funding Relationship to DHS, DCF or DWD - APPENDIX B The same Funding Relationship to DHS, DCF or DWD form previously completed for the CRC LOA should be used for the CRC Plan. Funded Programs Checklist - APPENDIX C The same Funded Programs Checklist previously completed for the CRC LOA should be used for the CRC Plan. Data Collection Service Delivery Our agency has a system that records the following: The race, ethnicity, sex/gender, disability status, and primary language of participants/applicants (Self-identification by the applicant/participant is the preferred method of obtaining characteristic data) Yes No Number of potentially eligible or likely to be affected or encountered Yes No Number of LEP individuals encountered by vs. walk-in Yes No Language spoken and/or dialect of LEP participants Yes No Number of eligible LEP participants by separate programs and the frequency of encounters Yes No Interpretation needs and preferred language of LEP participants Yes No The number of interpretation services were offered and provided to LEP individuals and the language group for the service Yes No The written translation of documents for LEP groups that meet the 5 percent or 1,000 threshold requirement Yes No Number of sign language interpretation requests received from deaf and hard of hearing participants Yes No Other accommodation requests and needs from participants with disabilities Yes No If you responded “No” to any of the above questions, describe your plan for addressing the requirement(s), including target dates for completion of milestones, below:
Has your entity completed a self-evaluation of its policies and practices to determine compliance with nondiscrimination on the of disability provisions? Yes No Are all your programs or activities accessible to individuals with disabilities? Yes No In choosing methods to make your programs accessible, have you given priority to those methods that allow individuals with disabilities to participate in your programs or activities in the most integrated setting appropriate? Yes No Have you maintained on file the following information: A list of interested persons consulted. A brief description of the areas examined and any problems identified, and a description of any modifications made. Yes No Has your entity designated at least one person to coordinate its efforts to comply with Section 504 and the ADA as the Equal Opportunity Coordinator? Yes No Has your entity adopted complaint procedures that provide for the prompt and equitable resolution of complaints alleging discrimination in benefits or service because of disability? Yes No Has your entity developed a transition plan to address barriers you identified in facilities that affect equal participation of people with disabilities in your programs and activities? Yes No Does your entity provide public notice that it does not discriminate on the basis of disability in print and audio formats on information that is intended for the public about the program or activity, including on your website? Yes No Has your entity included a nondiscrimination clause in your contracts with subrecipients? Yes No
Training Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 701 et seq.) 29 C.F.R. Part 32 disability Programs administered by DWD Division of Employment and Training Title IX of the Education Amendments of 1972 (20 U.S.C. § 1681 et seq.) 29 C.F.R. Part 36 sex Programs administered by DWD Division of Employment and Training Age Discrimination Act of 1975 (42 U.S.C. § 6101 et seq.) 29 C.F.R. Part 35 age Programs administered by DWD Division of Employment and Training Section 167 of the Job Training Partnership Act of 1982 29 C.F.R. Part 34 race, religion, sex, national origin, age, disability, political affiliation or belief Programs administered by DWD Division of Employment and Training OTHER FEDERAL PROVISIONS Community Services Assurance Provisions of the Hill-Burton Act Health Facilities receiving Funds Nondiscrimination Provisions of the Omnibus Budget Reconciliation Act of 1981, Public Law 97-35, as amended (Federal Block Grants) race, color, national origin, sex (Community Services Block Grants); race, color, national origin, age, disability, sex, religion (remaining block grants) Community Services Block Grant; Social Services Block Grant; Maternal and Child Health Block Grant; Projects for Assistance in Transition from Homelessness Block Grant; Community Mental Health Services Block
Grant; Substance Abuse Prevention and Treatment Block Grant Family Violence Prevention Services Act, 42 U.S.C. § 10406. race, color, national origin, age, disability, sex, religion Section 408 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 42 U.S.C. § 608 age, disability, race, color, national origin Block Grants for Temporary Assistance for Needy Families *This list is current as of November 2017. Please note, there may be other applicable civil rights provisions that have been omitted and the provisions may be subject to amendment, repeal or replacement. Additionally, each Federal agency may issue interpretative guidance on civil rights compliance, such as providing meaningful access to LEP individuals, which should be consulted. See e.g., 68 Fed. Reg. 47311 (Aug. 8, 2003) (HHS LEP Guidance); 79 Fed. Reg. 70771 (Nov. 28, 2014) (FNS LEP Guidance); 68 Fed. Reg. 32290 (May 29, 2003) (DOL LEP Guidance).