Civil Rights Corner

In this corner:

Mandatory Notices 2018

Training and Development Presentations

For alternate formats, call or email Geneva Watts at 586-4955;


DHS 2016 – 2019 Self Evaluation and Compliance Plan

September 2016 Transmittal ICF
Table of Contents
Executive Summary

Self Evaluation and Compliance Plan (Effective September 1, 2016)


Appendix A 
Acts, Acronyms, and Definitions

Appendix B
DHS Policies and Procedures (4.10.1, 2, 3, and 4)

Appendix C
Sample Mission, Vision, Pledge, and Service Standards

Appendix D
Sample Publication and Form (Access Hawaii; Request for Auxiliary Aid)

Appendix E
Sample Translation (Tagalog; Chinese)

Appendix F 
Sample Notifications and Description of Data Sources
Program Accessibility for Persons with Disabilities Notice
The Americans with Disabilities Act Prohibits Discrimination Notice
Nondiscrimination Notice
Notice of Due Process Standards

Appendix G
Discrimination Complaint Procedure (DHS 6000 and 6006)

Appendix H 
Title VI Civil Rights compliance Checklist (Sample)

Appendix I
Title VI Coordinator Description

Appendix J
Related Resources and Sample Data Source Descriptions
HHS Finalizes Rule to Improve Health Equity Under the Affordable Care Act
(Section 1557 – Sex Discrimination) May 13, 2016
Sample Business Associate Agreement Provisions
Sample Data Source Descriptions

Affirmative Action Plan  2016-2019

Language Access Plan  2016-2018

DHS Policies and Procedures  2016 Updates

Forms and Brochures

DHS 5000 – Offer and Acceptance or Waiver of Free Interpreter Services

DHS 5050 – Interpreter Form and Code of Ethics

DHS 6000 – Discrimination Complaint with Instructions

DHS 6006 – Consent Release Form

DHS 6007 – Complaint Withdrawal Form

DHS 6008 – Auxiliary Aid Request Form

DHS 6009 Request for Accommodation under ADAAA (Employees and Applicants for Employment at DHS) with Instructions