WPC^ XEtOHԘ5dy 06 %Rǥe1V1"J,Cw>PEJ[Q>S/_Ѽ4N 䃗UH8/K j>"qbQeٮ &}G{ b7DdPk z0&K$PfoO;ܫ*S8Xe5Y=A8=gskw`5dTpٜ#4!zʩ~#M*Vmz<% tGn_*x~ 0nn 0 0a 0:  0fa D+fafafa 0 #UN %M(N^ !w-41E mG\  `&Times New Roman' Race and Ethnicity SRS0eav .   <:Default ParaXXX0> .Header !>44 <DL!>0> .Footer !>44 <DL!>:8Page Number  '..      XXXXXXXX  _  yXXCFS4016Instructions X   y |(X @ |( @ |( @ |( @ |( @ |( @ |( @ |( @ |( @ |( @ y January2004  ̤y |( @ |( @ |( @ |( @ |( @ |( @ |( @ |( @ |( @ |( @ y̤ 󀀀Page    1    ݀of2 XXy (2$ &!..      XXXXXXXX  Table_A'dxdTable_BTable_CTable_D#|x(&$..      XXXXXXXXHP LaserJet 4100 Series PCL,,,,0(9 Z6Times New Roman RegularX56Z 6ownloaU &!..      XXXXXXXX  _       X̤XX InstructionsforReportingRace,Ethnicity,LanguagePreferenceandOtherCommunicationMedia   Tostandardizereportsonindividualraceandethnicity,theFederalOfficeofManagementandBudgethas = definedthevaluesthatstatesmustuseforfederalreports.Theuseofthesecodesapplytoallgovernmental X entitiesandarethesamevaluesusedforthe2000Census.Thisnewstandardizationsplitsoutraceand  ethnicity.Individualscandeclaretheirracetypeasoneoruptoanycombinationoffiveracetypes. z EthnicityisdefinedaseitherHispanicorNotHispanic.Thenewraceandethnicitycodesareasfollows.  9  RACE     * ddd Xdd Xdd X!!, , +  1' v  v @1 A ' v @ @'AmericanNativeorAlaskanNative* ?5 v @  @?K (X pK B ' p @ @'BlackorAfricanAmerican ?5 p@  @?K (X / K P ' / @ @'PacificIslanderincludingNativeHawaiian ?5 / @  @?K (XJ K S 'J @ @'Asian ?5J @  @?K (X  K W '  @ @'White ?5  @  @?K (Xl K O 'l @ @'Unknown-#!l @   -K (X+ K*_HealthWave_ԀpremiumsarewaivedforAmericanNativesorAlaskanNatives,soitisimportantthatifa F  personfallsintothiscategoryitisrecorded.   'O'istobeselectedonlyifraceisunknownto_JJA_Ԁorifthepersondeclinestoindicatearacecode. ' Apersonmaychooseanycombinationofonetofiveracecodes,butif'O'isselected,otherracecodes  cannotbeselectedwithit. d ̤̤ ETHNICITY  + *p dd   !!p, ,4 +  1'M!M @1 H 'M"@ @'HispanicorLatino ?5M#@  @?K (Xh K N 'h $@ @'NotHispanicorLatino-#!h %@   -K (X'KӁ 'H' shouldbeselectedifapersonchoosestoidentifyhimselfasHispanicorLatino. &  'N' shouldbeselectedifapersonchoosestoidentifyhimselfasanethnicityotherthanHispanicorLatino. d( Onlyoneethnicitychoiceisallowed,i.e.,apersoncannotselectboth'H'and'N'. *   LanguagePreferenceandOtherMedia  `, Inordertocomplywithfederalrequirementsthatconsumersreceiveequalaccesstoservicesprovidedby  . _SRS_Ԁandtodeterminethekindsofresourcesnecessarytoassiststaffinensuringmeaningful !A/ communicationwithlimitedEnglishproficientclients,statesarerequiredtocapturelanguagepreference \"0 information #1 Thefollowingtablesshouldbeusedtoenterdataprovidedbyconsumers. X% 4 *p dd 4 4 !!p,V ,  ,W , ,W ,= +  5+&z"6&z" @5  LANGUAGESpoken(SP)andWritten(WR) B8 &z"7@    @BK (X'9#K AR ''9#8@ @'Arabic ''9#9@ @' HN ''9#:@ @'Hindi ''9#;@ @' PT ''9#<@ @'Portuguese ?5'9#=@  @?K (XT(#K _BN_ 'T(#>@ @'Bosnian 'T(#?@ @' IT 'T(#@@ @'Italian 'T(#A@ @' RU 'T(#B@ @'Russian ?5T(#C@  @?K (X)$ K CA ')$D@ @'Cantonese ')$E@ @' JP ')$F@ @'Japanese ')$G@ @' SC ')$H@ @'_Serbo_ԄCroatian ?5)$I@  @?K (X)v% K CZ ')v%J@ @'Czech ')v%K@ @' KN ')v%L@ @'Korean ')v%M@ @' SM ')v%N@ @'Somali ?5)v%O@  @?K (X*W& K DU '*W&P@ @'Dutch '*W&Q@ @' LA '*W&R@ @'Lao '*W&S@ @' SP '*W&T@ @'Spanish ?5*W&U@  @?K (Xr+' K EN 'r+'V@ @'English 'r+'W@ @' MA 'r+'X@ @'Mandarin 'r+'Y@ @' SU 'r+'Z@ @'Sudanese ?5r+'[@  @?K (X1,' K FR '1,'\@ @'French '1,']@ @' MK 1,'^  ',(_@ @'MonKhmer '1,'`@ @' _TG_Ԁ '1,'a@ @'Tagalog ?51,'b@  @?K (X-S)K GE '-S)c@ @'German '-S)d@ @' NN '-S)e@ @'None '-S)f@ @' TH '-S)g@ @'Thai ?5-S)h@  @?_K (X\K GK '\@ @'Greek '\@ @' OT '\@ @'Other '\@ @' UN '\@ @'Unknown ?5\@  @?K (XK GU '@ @'Gujarathi '@ @' PE ' @ @'Persian ' @ @' UR ' @ @'Urdu ?5 @  @?K (X~K HM '~ @ @'Hmong '~@ @' PL '~@ @'Polish '~@ @' VN '~@ @'Vietnamese C9~@  @CK (X=K0&$=@   0K (XXKӁMostSpokenLanguageandWrittenLanguagecodesareselfdefined.'None'canindicatethattheclient  doesnothaveawrittenoraspokenlanguage,orthattheyhaveonebutnottheother.Thefieldsare z separate,thereforethesamecodemaynotnecessarilybeenteredinbothfields.Having'None'selectedfor  9 bothmayindicatethattheclientusesBraille,Sign,etc.Forexample,ifthepersonSignsandcanread T  EnglishthenSpoken=NN,Written=English,OtherMedia1may=S,E,orOandOtherMedia2=T,R,   Oorwhateverisappropriate.  v ЁForsomelanguagesitmaybenecessarytoenteradditionalinformationsuchascountryoforigin(aswith P  Spanish)ortribal/clanlanguage(aswithSudanese,Somali).AswithGermanMennonite,forexample,   workersshouldenter GEintheappropriatelanguagefieldand GermanMennoniteinthecomments r  fieldontheCFS4016.Itisbestthattheinterpreterbeingusedknowswherethepersontheyare 1  interpretingforisfromorwhichdialectofalanguagetheclientusessothattheycanbemoreeffective. L  SelectingOTindicatesthattheconsumer'slanguagepreferenceisnotincludedinthechoicesgiveninthe n ! table(Swahili,forexample)andtheappropriatelanguageshouldbeindicatedinthecommentssectionof -" theCFS4016. H# * d dV V  W W W W= =!!, , , , , , +  5+j%j @5  OTHERMEDIA B8 j&@    @BK (X)K B ')'@ @'Braille ')(@ @' N '))@ @'None ')*@ @' S ')+@ @'AmericanSign ?5),@  @?K (X/K E '/-@ @'SignedEnglish '/.@ @' O '//@ @'Other '/0@ @' T '/1@ @'TDD/TTY ?5/2@  @?K (X5K L '53@ @'LargePrint '54@ @' R '55@ @'Relay '56@ @' V '57@ @'VoiceSynthesizer C958@  @CK (X;K0&$;9@    0K (XVK̤̤TheOtherMediafieldcapturesaclient'sneedforTDD/TTY,Braille,signlanguageinterpretation,etc. : OtherMediareferstocommunicationmethodsusedbyvisuallyorhearingimpairedindividuals.Braille, e; largeprintandvoicesynthesizer(JAWSandothersuchprograms)maybeusedbyvisuallyimpaired, $< whereasSignedEnglish(signedEnglishlikesentencestructure),AmericanSign(signlanguageofanother ?= structure),Relay(useoftelephonebyonepartyandamechanicalassistivedevicebyanother),or > TDD/TTY(mechanicaltelephonicdevice)maybeusedbyhearingimpairedindividuals. a? RememberthatitispossibletolistmorethanoneOtherMediaoption.Forexample,Vmaybeenteredin ;A thefirstOtherMediafieldandBinthesecond(orN,O,orwhicheverisindicatedbytheconsumer). B Thecodesthatshouldbeenteredinthelanguagepreferenceandothermediafieldswillbedeterminedfrom  ]C informationconsumersprovide.Donotassumethelanguage/othermediapreferencesofconsumers. x!D Entering EnglishbecausethemajoritylivinginKansasspeakEnglishdoesnotmakeiteasierto 7"E communicatewithalimitedEnglishproficientpersonwhentheycallorcomeintotheoffice.Moreover,it "F willunderrepresenttheneedsofyourArea.Similarly,havingknowledgethatsomeoneisfromMexico #YG doesnotmeanthatthatpersonspeaksSpanish.Theymayspeakoneoftheindigenouslanguagesoreven t$ H German.Ifaconsumerdoesnotprovidearesponsetothelanguageorothermediaquestions,workers 3% I shouldenterUNintheLanguagePreferencefieldsandNintheOtherMediafieldswithanoteinthe %!J appropriatecommentssectionthatthelanguageorothermediapreferenceisunknownorthattheclientdid &U"K notspecify,etc. p'#L XX̤