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ATTACHMENT 1B ELIGIBILITY CERTIFICATION CLIENT NAME:(including nicknames or other names used)ADDRESS: CURRENT: STREETCITYZIP DEFENDER: ETHNICITY: IS THE CLIENT DISABLED? Male Hispanic Yes No Female
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How to fill out guidelines on raceethnicity data

01
Begin by carefully reading the instructions provided for the race/ethnicity data section.
02
Determine which categories are included for race and ethnicity (e.g. White, Black, Hispanic, Asian, Native American).
03
Select the most appropriate option that represents your race and ethnicity accurately.
04
If there is an option to select more than one race/ethnicity, choose all that apply.
05
If none of the listed options accurately represent your race/ethnicity, choose 'Other' and specify in the provided space.
06
Review your selection to ensure accuracy before submitting the form.

Who needs guidelines on raceethnicity data?

01
Organizations collecting demographic data for research purposes
02
Government agencies gathering data to monitor disparities
03
Healthcare providers updating patient records
04
Schools and educational institutions reporting on student demographics
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Guidelines on race/ethnicity data are a set of instructions and recommendations on how to collect, report, and analyze information related to the race and ethnicity of individuals.
Organizations or entities that collect data on individuals and are subject to regulations or requirements related to reporting race/ethnicity data are required to file guidelines.
Guidelines on race/ethnicity data can be filled out by following the instructions provided in the document, ensuring that accurate and complete information is reported.
The purpose of guidelines on race/ethnicity data is to ensure the standardized collection and reporting of race and ethnicity information in order to promote equity and prevent discrimination.
The guidelines typically require information on the race and ethnicity of individuals, as well as details on how the data was collected and any relevant limitations or considerations.
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