Change in Disability Status Survey

Employees who have a change in disability status are requested to voluntary self-identify their status. The disability data collected is critical to the success of California Department of Human Resources (CalHR) to monitor and evaluate the provision of equal employment opportunity and non-discriminatory employment practices within the state civil service, and to gauge the success of recruiting and retaining a diverse workforce.

The data requested on this survey is for statistical purposes only to meet statutory requirements and will not be used for any employment decisions. Your information is being collected by CalHR and will be kept confidential. No personal identifying information will be released to other state agencies.

Please note that some of the questions ask if you have difficulty performing various activities of daily living such as bathing, dressing, etc. and if you have difficulty performing these activities because of a physical or mental impairment or medical condition. Although these activities are not work-related we need to obtain data which is consistent with surveys conducted by the U.S. Census Bureau and other federal agencies.

* Required Field
Disability Status

Check all that apply:

As it appears on your pay stub
* Required Field

Privacy Notice on Information Collection

The California Department of Human Resources (CalHR) is committed to maintaining the privacy of your personal information. All information we collect is governed by the State of California Information Practices Act of 1977 (Civ. Code, §§ 1798-1798.78), Government Code section 11015.5, Government Code section 11019.9, and the California Public Records Act (Gov. Code, §§ 6250-6270.5).

Legal Authority for Collection and Use of Information

CalHR, Office of Civil Rights, is requesting the information specified on this form pursuant to Government Code sections 19233, subdivision (b) and 19704, subdivision (b).

The information collected will be used for statistical analysis as required under Government Code sections 19792 subdivisions (h), (i), and (j); and 19233, subdivision (b). In addition, under Public Law 88-352, Title VII of the Civil Rights Act of 1964, all state and local governments are required to maintain records and submit a report to the Equal Opportunity Commission. This information is required to comply with The Office of Management and Budget's (OMB), Revisions to the Standards for Classification of Federal Data on Race and Ethnicity.

Disclosure and Sharing

CalHR does not, under any circumstance, sell your electronically collected personal information. Government Code section 11015.5, subdivision (a) (6) prohibits CalHR and all state agencies from distributing or selling any electronically collected personal information, as defined above, about users to any third party without the written permission of the user. Any distribution of electronically collected personal information will be used solely for its intended use.

However, we may share your personal information under the following circumstances:

  1. In published statistical reports. No names, Social Security Numbers, or other personal identifying information will be provided through these statistical reports.
  2. You give us written permission and consent.
  3. We may release information to a party with a legal authority, such as a subpoena.
If you elect not to provide the information requested, CalHR will not be able to effectively evaluate the representation of the state civil service workforce.

Department Privacy Policy

For more information on how we care for your personal information, please read our Privacy Policy.

Access to your information

The CalHR Office of Civil Rights is responsible for maintaining collected records. You have a right to access records we maintain containing your personal information. To request access, contact:

Workforce Analysis Program Manager
1515 S Street, 400N
Sacramento, CA 95811