MEMORANDUM
DATE:
November 8, 2004
TO:
ALL STATE AGENCIES AND EMPLOYEE ORGANIZATIONS
FROM:
California State Personnel Board
Merit Employment and Technical Resources Division
SUBJECT:
STATE EMPLOYEE DISABILITY QUESTIONNAIRE – SCANNABLE
FORMAT – STANDARD 740
By law, all employers are required to provide equal employment opportunity to individuals
with disabilities. Government Code Section 19233 requires that the state survey employees in
each department to determine the number of employees with disabilities for purposes of
developing employment goals and ensuring equal employment opportunity. To determine the
status of these efforts, complete and accurate statistical information regarding disabled
representation in state service is required.
The State Personnel Board (SPB) has developed a new scannable State Employee Disability
Questionnaire, Standard (Std) 740 (replacing forms SPB 131 and 131a). The new Std 740 solicits
the same information as the prior State Employee Disability Questionnaire and may be used for
gathering information from new and rehired employees, as well as for periodic resurvey to update
employee disability information. The SPB is no longer able to process the SPB 131 and 131a.
Departments may recycle or dispose of the old forms currently on hand and order a supply of the
scannable Questionnaire through the Department of General Services at the following address:
FORMS MANAGEMENT CENTER
Office of State Publishing (IMS P-6)
344 North 7th Street
Sacramento, CA 95814-0291
Service Center:
(916) 324-4635 or
Toll free: (800) 964-3214
Fax: (916) 324-9908
State Employee Disability Questionnaire
November 8, 2004
Page Two
For your convenience, attached are updated procedures for identifying employees with
disabilities and a sample memo to employees regarding the survey. If you have any questions
about the procedures, please contact Matilda Bannerman-Richter in the Office of Civil Rights
at (916) 653-1276.
Karen Coff