Civil Rights Compliance Clarification Communication from DHS

On August 22, 2022 we sent you a message regarding changes in how you provide information related to civil rights compliance.   That communication is below for your reference.   Since that time, we have received several questions and we want to provide further clarification to you.

  1. When sending the CRC form or the CRC attestation form please send as a PDF.  Please do NOT send as a secure file, secure email, or link to a secure portal to retrieve the document. We are unable to access those forms and they will be returned. When emailing the forms for submission:
    1. Use the following naming convention in the subject line when submitting Renewal HS2125
      • Attestation – Program Office – Name of Facility or Agency – License number or APP number if assigned.  Examples:
        • Attestation – OCYF – Apple Agency Home – 123450
        • Attestation – ODP – Apple Agency – APP-00123456
    2. Use the following naming convention in the subject line when submitting a new application HS2126
      1. New – Program Office – Type of Service – Name of Facility or Agency Examples:
        • New – BHSL  – PCH – Apple Personal Care Home
        • New – ODP – Life Sharing – Apple Agency – APP-00223456
  1. In the Office of Developmental Programs (ODP) and the Office Mental Health and Substance Abuse Services (OMHSAS) there are providers who have one license that cover multiple locations.  In this case, you only need to submit one form (either the HS 2125 or the HS 2126) and list the addresses of each satellite site/location that falls under that license.
  2. If in the past, you completed the Civil Rights Compliance Questionnaire (CRCQ) annually.  As part of the renewal license process, you will need to complete the Civil Rights Attestation (HS2125) when you receive your next notice to complete the renewal application process.
  3. If you have a current license your CRC was approved. You will need to complete the Civil Rights Attestation (HS2125) when you receive your next notice to complete the renewal application process.
  4. For Assisted Living and Personal Care Home providers, when submitting the renewal application for a license, the renewal application, renewal application fee, and the Attestation (HS2125) must be sent hard copy in one envelope to Licensing Administration in Harrisburg as noted on the cover letter of the renewal application packet.   
  5. Please ensure that the “Non-Discrimination in Employment” policy statement and the “Non-Discrimination in Services” policy statements issued by your facility contain updated contact information (as indicated below). If this administrative update is the only change that has occurred since the facility’s last license was issued, it is not necessary to provide updated copies to the Department as part of Form HS 2125. 

Commonwealth of Pennsylvania

Department of Human Services

BEO/Office of Civil Rights Compliance

Room 225, Health & Welfare Building

P.O. Box 2675 Harrisburg, PA 17120

Inquiries: (717) 787-1127

Email: [email protected]


U.S. Equal Employment Opportunity Commission 801 Market Street, Suite 1000

Philadelphia, PA 19107-3126

Inquiries: (800) 669-4000

https://www.eeoc.gov/federal-sector/overview- federal-sector-eeo-complaint-process


Pennsylvania Human Relations Commission 333 Market Street, 8th Floor

Harrisburg, PA 17101

https://www.phrc.pa.gov/File-a-complaint

Inquiries: (717) 787-4410

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