- File a Civil Rights Complaint
- English form
- English form instructions
- Hmong form
- Hmong form instructions
- Spanish form
- Spanish form instructions
The Department of Health Services (DHS) Civil Rights Compliance (CRC) Office works with DHS contractors, grantees, subgrantees and other providers that receive federal financial assistance through DHS to ensure compliance with federal and state laws, regulations, and departmental policies and procedures prohibiting discrimination in employment and service delivery.
The CRC Office is responsible for developing and implementing DHS Civil Rights Compliance Requirements for entities that receive federal financial assistance through DHS. Federal civil rights laws apply equally both to DHS and its contractors, subcontractors, and vendors when federal financial assistance is extended. Federal Civil Rights Laws and other statutes such as Title VI and Title VII of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, Section 504 of the Rehabilitation Act of 1973, the American with Disabilities Act of 1990 as amended, Title IX of the Education Amendments of 1972 as amended, and other applicable regulations confer analogous authority to DHS to develop and implement likewise assurances of compliance of contractors, subcontractors, and vendors that operate programs, services, and activities with federal financial assistance. The CRC Office also investigates discrimination complaints against contractors, subcontractors, and vendors receiving federal financial assistance.
Civil Rights Compliance Requirements for 2022-2025
The CRC requirements describe what agencies receiving federal funds from DHS must do to ensure nondiscrimination in service delivery, including providing access to individuals with limited English proficiency (LEP) and individuals with disabilities.
These CRC requirements are intended to meet the civil rights requirements of the U.S. Department of Health and Human Services (HHS); and the U.S. Department of Agriculture, Food and Nutrition Services (USDA-FNS) by getting assurances from DHS recipients that they will comply with applicable federal civil rights provisions. Recipients are required to submit a Civil Rights Compliance (CRC) Letter of Assurance and, for larger recipients, to complete a CRC plan for the period of January 1, 2022, to December 31, 2025.
Civil Rights Compliance Requirements, P-00164 (Word)
Appendix A: Letter of Assurance, F-00165 (Word)
Appendix A-1: Recipient Contact Information, F-00165A (Word)
Appendix A-2: Funding Relationship to DHS/DCF, F-00165B (Word)
Appendix A-3: Funded Programs Checklist, F-00165C (Word)
Appendix H: Customer Service Population Analysis (CSPA) Data Chart, F-00165D (Word)
Appendix I: Limited English Proficiency (LEP) Customer Data Analysis Chart, F-00165E (Word)
Letters of Assurance Submissions
Please submit your letter of assurance and accompanying appendices to:
dhscontractcompliance@dhs.wisconsin.gov
Department of Health Services
Division of Enterprise Services
Bureau of Strategic Sourcing
Affirmative Action Plan/CRC Coordinator
1 W Wilson Street, Room 672
PO Box 7850
Madison, WI 53707-7850
Technical Assistance
Department of Health Services
CRC Officer
1 W Wilson Street, Room 651
PO Box 7850
Madison, WI 53707-7850
608-266-1258 (Voice)
711 or 800-947-3529 (TTY)
608-267-1434 (Fax)
dhscrc@dhs.wisconsin.gov
Accessibility Resources
This webpage provides links to informational resources to make programs, services, and activities accessible to persons with disabilities as required by the Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.
Limited English Proficiency Resources
This page contains limited English proficiency information on resources for recipients of federal financial assistance from DHS.
