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.)
Name (Last, First, Middle Initial)
Social Security Number
Birthdate (Month and Year)
Agency Use Only
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 attempt 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. It
is 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 requested 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. If SSN is not provided, however, other agency sources may be
used to obtain it.
Specific Instructions: The two questions below are designed to identify your ethnicity and race. Regardless of your answer to
question 1, go to question 2.
Question 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.)
U Yes U No
Question 2. Please select the racial category or ca