Civil Rights Compliance Requirements for 2014-2017

Funded recipients, sub-recipients, contractors and vendors receiving federal and state funding from the Wisconsin Department of Health Services (DHS), Department of Children and Families (DCF), or the Wisconsin Department of Workforce Development (DWD) are required to submit a Civil Rights Compliance (CRC) Letter of Assurance and in some instances must complete a Civil Rights Compliance (CRC) Plan for the period of January 1, 2014 to December 31, 2017. Funded recipients and sub-recipients include counties, municipalities, school districts, universities, profit and non-profit entities, and certain vendors. The following page contains the instructions and templates essential to completing the CRC Letter of Assurance and for completing a CRC Plan to meet civil rights compliance requirements.

Full CRC Plan and Letter of Assurance (2014-2017)

• Instructions and Templates for CRC Letter of Assurance and CRC Plan (PDF, 717 KB)
• Civil Rights Compliance Plan Template (Fillable Word, 405 KB)

CRC Plan by Parts

• Civil Rights Compliance Plan (Fillable Word, 405 KB)
• Civil Rights Compliance Letter of Assurance (Fillable Word, 136 KB)
• Appendix A: Signature Page (Fillable Word, 116 KB)
• Appendix B: Funding Relationship (Fillable Word, 128 KB)
• Appendix C: Funded Program Checklist (Fillable Word, 185 KB)
• Appendix D: Equal Opportunity in Employment and Service Delivery Policy (Fillable Word, 41 KB)
• Appendix E: Equal Opportunity in Employment and Service Delivery Statement USDA/HHS/DHS Lobby Posting (Fillable Word, 40 KB)
• Appendix F: Equal Opportunity in Employment and Service Delivery Statement Health Care Facilities and Providers (Fillable Word, 40 KB)
• Appendix G: Nondiscrimination Statement SNAP/FoodShare, WIC, TEFAP, FSET website (Fillable Word, 31 KB)
• Appendix H: Limited English Proficiency Policy Statement (Fillable Word, 106 KB)
• Appendix I: Employment or Service Delivery Discrimination Complaint Form and Instructions (Fillable Word, 146 KB)
• Appendix J: Complaint Consent/Release Form (Fillable Word, 111 KB)
• Appendix K: Acronyms (PDF, 19 KB)
• Appendix L: The Wisconsin Programs and Services Access Self-Assessment Checklist (Fillable Word, 327 KB)

Translations

Note: Translations for appendices will be added as translations become available.