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U S. Office of Personnel Management

Guide to Personnel Data Standards

ETHNICITY AND RACE IDENTIFICATION

(Please read the Privacy Act Statement and instructions before completing form.)
Social Security Number

Name (Last, First, Middle tnitial)

?lri iT i ffr;e. hirc*&r

Agency Use Only

ffi

Birthdate (Month and Year)

lfJrrl.cr

AftTt

Privacy Act Statement

Ethnicity and race information is requested under the authority of 42 U.S.C. Section 2000e-16 and in compliance with
the Office of Management and Budget's 1997 Revisions to the Standards for the Classification of Federal Data on Race
and Ethnicity. Providing this information is voluntary and has no impact on your employment status, but in the instance
of missing information, your employing agency will aftempt to identify your race and ethnicity by visual observation.
This information is used as necessary to plan for equal employment opportunity throughout the Federal government. lt
ts also used by the U. S. Office of Personnel Management or employing agency maintaining the records to locate
individuals for personnel research or survey response and in the production of summary descriptive statistics and
analytical studies in support of the function for which the records are collected and maintained, or for related workforce
studies.

Social Security Number (SSN) is reguested under the authority of Executive Order 9397, which requires SSN be used
for the purpose of uniform, orderly administration of personnel records. Providing this information is voluntary and failure
to do so will have no effect on your employment status. lf SSN is not provided, however, other agency sources may be
used to obtain it.
Specific lnstructions: The two questions below are designed to identify your ethnicity and race. Regardless of your answer to
question 1, go to question 2.

1. Are You Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race.i
Question

l-lYes.frtto

Question

2. Please

select the racial category or categories with which you most closely identify by placrng an "X" in the appropriate

box. Check as many as apply.

RACIAL CATEGORY
(Check as many as apply)

SAmerican lndian

or Alaska Native

DEFINITION OF CATEGORY

A person having origins in any of the original peoples of North and South America
{induding Central Americe}, and who maintains tribal affiliation or community
attachment.

c Asian

A person having origins in any of the original peoples of the Far East, Southeast
Asia, or the lndian subcontinent including, for example, Cambsdia, China, lndia,
Japan, Korea, Malaysia, Pakistan, the Philippine lslands, Thailand, and Vietnam,

[l

alact< or African American

A person having origins in any of the black racial groups of Africa.

fl

Native Hawaiian or Other Pacific lslander

A person having origins in any of the originat peoples of Havraii, Guam, Samoa, or
other Pacific lslands.

wnrte

A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa.
Standard Form 181
Revised August 2005
Previous editions not usable
42 U.S.C Section 2000e-16
NSN 7540-01-099-3446

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Cover Sheet

Title 4 U.S,e 1-4 Artlcltl

-*: rgr*ssirlnal Rer:ord

A32220 of May 11, 1955

Eect:ons 7

f,?l{a 5S U.5.C

1S3? TradinE

and 56 unlted Nations Charter;

witlt the

{cl,l (e), 9, 1Z

lnter-American Dee
the right of lndigenu

Title 42 U.S.C lgBS

45 stat.401;54 stat

Act

Titl 28 U.S.c 1133.

t r;:'fl*:* rrfflce

of

ent and Budget

7P5 17th Street,

1rV*shlngton, l)C

Fax 202'395-3888
FrCIrn;

Michael

Ff.i15;r 1&L

Forrt

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H. RES. 194

,\pologizinu fiti' llte ettslttvetltctlt trttd

lar, ia1 seg-r'cgat

iort

o1'

^\frit'ari -^\li I ct'it'

at ts

IN TIIII] IIOI-SE [)Ir HI]PRIISLNT-\TIYES

]li'

Irt,:ltit',t,tlr' : 7, 2()07
(,loIII.lN (tor'hiurst'1f. lh'. JtulNstrN ofl ticrn';1ta. )ls 'l-\t'I(srlr-i'titi of
Tcxas. ]h.. Rti,ttlr o1' Pettnsrjvtttritt, lli'. \YtiXlnrl, fIs. Iitl't'-t"t'ttlt'ti, lIs'
\\irol.siir'. llr.. P,r.r,l,osr, .\ls. Lrn, JIr'. ,\lt'(iot-i.:tlr, ,\ls. st'II-\Iio\Yril(\',
Jh.s. Jlr.t.oNiiy of NeI' Yor.k. ]h'. t'itxttitls, ]h'. ]lorllx of \-ir'3irritr, lL'.
('-u,u-\No, Jh'. R-t-xrirt,. llr. P-r.r-xri. JII'. 'Itil"t''iltlsox' JIr' ElLlsoN, )h"
]h'. IItSt'iitir".
-\1. (inctix of 'lcxtts, f [r'. I'il"L'r'n1l!'IIiL1]. lls. \\'-r'rsox'
JIr'. I).rt'is of
JIr..\trlitllill-\N,
Jh,. ('r,ti-s'tin, lls. C-ulsttx. lh'. Isti-rpr,,
H-Utc. llr'
(ieolgia.
lIi'.
Jh'. lt',tltit'itollltIE.
-\ltrlrarna. JIi'. Lnrvls of
I{rixxriny. Jls. Ii-tl.tllvls, llr'. II<lotis, }h'. Irtt,Nlil'1, r\h'. Ilosll-t' atrtl
11.. Iir.t'txtglI) strllllittetl thc tirlltxring lesolutiotr; s-hit'h l'as trrft't't't'r1 trl
tlrc Corntnittec (lt) tlrt' ,Iudiciar'1'

RESOLUTION
,\pologizing tbr tlte eltslttvcljll'ut illl(1 fa('iill st'gt't'giltion ilf
-,\ft'it'

ar

r--\lI

t' l'i ('il

ts.

.\fi'it'atts alIcl their clest'ettclatits \\'ere

in tirtl United States alid tlie 1ll ,\mcri(:ar] colo-

\Yliet'eets rnillittris o1'

etlsiavi't1

nics frottr

ii 19

tlu't-ng'h 18ti5,

\\'lrereas slavet'f iri r\titerit,a reselnl)letl llo {)tl)el' itirtti tlf irn'oluutat.), Seiaitu(le knorui itr histor1., as -\ti'iealls \Yerc CaI)turcrl aud Sold at aucrtiou lilie itranitttatt: ol-ijects 0f ill]irr... l.,.

\\-hereas ,\fr.icarrs forcecl into slaverl' \rere bnrtalizecl, liurriiliatcc1, clelrumanizecl, a,lld su.bjt'ctccl to tlte indignitl' of

being stripl.red of their naines ancl herita'ge;

\Vlreretis enslatveci faniilies \\rere tortt itptli't after ltavittg beert

solil sellrrratell' from one another;

\\l1g1eaS tlitr st'stcnt of sltlvett ttnrl tlttr tisi't'ral racisrn against
it rlepenclecl llel)ersolts rlf -,\frit'att clest't'ttt upoll u'Iiit'lr

e,trtlcliecl i1 the Natiotr's srlcial fallric;

\\\ereus sluven- rvAs uot otticiallv abolisirerl until the passagtl
of' tire 13th Antr.rrclnterit to tlre Llriited States Lloristitution in 1865 aftei' thc cnd of tlie cliiil \\'ar" $'hich u'as
citt]1e

fouglit ovcr thc slaver]'issuc:

\\'lterezrs trfter emattciptttion frorn 2't(i 1'ears tif slat'en', 'i\fi'icarr-r\mer.icarrs Sooll Sil\\' the flcetrlg' politiclal, social, a'ncl
economic gains theY niatle cluring Reconsti.tlction ertisceratecl l.r;- rirulertt rttt'istit, l1-rrt:liilrgs. tliserifrantrltisemettt'
Riack coclts, aircl racial seglc'gation ia$'s that imposed a
rigid S).stem of officiallv sanctiont'rl r'acial st'gi'egatiorr in

rrirtuall.r' il,ll areas of Iife:

\\'hcreas the sr.stein of ck, ju|e l'acial segrerg'atirlrt klrorur as

...Iitri (.1.o\\.,,, rr'}ritl}r iI1.oS(, irr ccrtttitr llarts tlf tlrc Naticlrr
folkrr.r'irrg tlre Llir.il \Yat' to t't'ettte st'partrte itlt<1 uttequtll
societies for l.hites anr] ,\frican-Americans, \\'a,s a direct
result of the r,acisni against pel'sons tlf l\trica,n clestleut
e tI

gettclt'recl b.v tl;1YErl\rj

\Yltereas tlie sYstcil of ,Iint (,'rott' Ia$'s officia']l1' existt'cl into

after the official encl of sla:n'erJ'in

,\nericn-urrtil congress took zrctititt to encl it, but the
yL'stig,es of Jim Crou' continue to this clar';

the 1t)ti0)s-a

crL.ututl,

\Yhereas Alricait-'\rnericaus coiltinue to suffer fi'om the cons1'sseqrrelr(.es of siar,er)' Lulcl Jirn (lro\\'-lorig after llotli
oHRES 194 IH

:l

tenrs \\'el'e fil'nialh- altolisirecl-flvv1;11oli ettot'tttrtus dillllilg.le

attcl ioss, ltoth tang'ihle autl intang'illle, inclurlirtg tllc loss

of lnunan digrritl' and liltertr.. tire firistration of cal'eel's

atrtl professionrrl lives, anci tlte ktrig-terni loss of iitt'titiie
antl opportuiritl';
\\'lrct'eas tlte stot'r' of tht, t,ttslttvettteltt ttitti c1t,jui'c scglegtttiott
o1' ,\ft'it'itit--,\ittet'it'tttts tttttl llre cleltlttliitttizirrg' ittt'ot'ities

cornrriittetl itg'ailrsit thern sltonltl trot ltr' lturgetl fi'oiu oI'

ittitriittizt'cl in the tcliiuq of ,\ttttli'icatt lti-stot'r'l
\\'ltereus oir Jtrl1'8,200;. <ltrrirrg'zt trip to Li,i'ee Islartd, Settcg'al, a fot'tuttt' slayt' port, Plesiticut Gc<lrg'c \\-. lJlrsh acknou'lcclgecl slar-et.r"s contirtuing legttcv ill Atiei'icrarl lifc
irntl the treecl to t:otrfrorit that legacv rt'ltett he stateti tliat

ollg of' thc greatest ct'iurcs of histcli'.r'

. The racirtl bigotn' t'ec1 lri' slavet'1' cliri not cnd \Yith
slavei'.1' or l'ith sey,^regatiorr. ^\rtcl lllilll)' of tlle isstlcs tlrat
still ti'oulrlc Anerica ltalt, t'oots itr the llitter ex1)t'Litlnce
of otht:r tinres. Brtt ltort'evt,t' lott5l' the joulnc\', 0111' tiestinl'
is set: lil,lertr- arrtl .irrstit'e for ttll.'':

slat'ct.r,

"\\'aS

\\'itt'r't'As 1'r'esitlertt tlill (llirttott ttlso aclititxr-lt'c1eet1 tltt'tlt'eirsetttetl 1l'oltlt,ttts t'aitsctl lt1' tlie r:otitittuitlS' lt'gitt:r- etJl l'tttrisnr itgairist -\ft'it.itrr--\titelit'atts tlrttt Ileg'arr u'itlr slar-t-'t't'
u'licn lit' initiatctl tr trational dialogtte allortt t'acei
\Yhereas a g'rruuine apologl- is itn itrtlrortaut ttitcl ile(ressill'\first stelt iri tlte l)ro('esri of t'aeial re't'tlttt'iliiitiort;
\Yirercas an altologr- for cerrtui'ics of ltrntal tleiitrtnatrization
arr<1 iirjustictts tttttttiot el'aSe tittl pttst, but. corrfbssirln of
tlie rt'nittgs (rolltnitterl t'att slteecl t'zit'iitl lretrlirrg ztttcl t'et:oirciliatiotr ancl hc.l1l ;\ltcr-icatts cottfi'ottt the ghosts of

their piist;

\\'lrere:is tlre legislature, of tlre cornnrorm.ealth

of \-irg.irria Ir.s
rt'ce.tl.r' tal<e, the lc,ar1 i, aclolrtil]g, a r.esoi,tio,
officiall'
cxp..ssi.g' approl;r'iate r.erllors(, fbr sl,r,.r.r. tr,r1
tLther
State iegislatrr|es zlt'e t'rtrrsiclerirrg' siniilar. resolutit)r)s;
rprcl
\\'lrt'r'eas it is iinllor.tarit fil, thj,s courrtr.r..
u.hir,h
]eg.a11, l.c.{)g:

rrizecl slaYt,r'r' tlrr.ung,li

its corrstitutioir

arrd

its

Ll,..s,

t,

ii litrrrrtil alloltlgr' 1in' slrrverl' arrcl firr. its sll(,(.r,risior,.

,Iir, c..'', so that it ciill ,lo'e f.^r'.rcr a.cr sc.r< ].e(io,ciliati,r, .iusticr., .rl{1 lru.*irrrr- tbr. irll ,f its citizers;
tttttl<e

N{)t\,, tlrerefor.c,, lle

1

Resrlt:etl, That the llouse, of

(1)

2
a

it

trclinou{eclges

lte1tr.ec6,11{;1f

the fitnrlttrnurtrr] irijustire,

(,t'rrelt\., ltr.utalit.r-, atid inlrtinrarritt-

,Iiil

of

slaver.r, trnd

Clou-;

(2)

i1-1,<-

upolog;iz.s

t'

A','ictrrr-A,er.i**rs on bcrrulf

,f

conrnrittt'r1 agttirrst tlrcn.r itrrtl tix,ir. Anct.stor.s

u.lto
sritiil'ecl ulr'lt,r. slirr-t.r.r- iurrl .Iinr ('i,ou.r trrrrl

tlre pe,pie

(i3

,f

trre I--ritt,cr slirtes, fir. trre

) exll'esses its t,,rrr,ritrir.,1 t,

\\,r.orrg,s

r.er.tif'r- trrt, rirr-

l0

g,t't'irrg collse(lrr(,,ces

11

ag'.irst Ati'icair-a,e.ica,s u.cler. slti'r,rl. irrrd,Jirrr

12

c.,*'

13

yiolations irr the frrturc.

.HRES

194

arrrl

t,

of tir. r,istleeds co,,,itt.il

stolr tlie

o(,(.ar.rL,rl(.e

,f ]*r,r,rr ris.irts