Important Notice – Immediate Action Required for Regulatory Compliance – Please Read Carefully 

You are receiving this message because you hold a license to operate a facility licensed by the Pennsylvania Department of Human Services (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

1. Use the following naming convention in the subject line when submitting a new application HS2126
   • 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

2. 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.
3. 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.
4. 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.
5. 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.   
6. 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: RA-PWDHSCivilRights@pa.gov

Office for Civil Rights

U.S. Department of Health and Human Services Centralized Case Management Operations 200 Independence Avenue, S.W.

Room 509F HHH Bldg

Washington, D.C. 20201

Customer Response Center: (800) 368-1019 TDD: (800) 537-7697

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

Inquiries: (717) 787-4410

Previously Sent August 22, 2022:

Important Notice – Immediate Action Required for Regulatory Compliance – Please Read Carefully 

You are receiving this message because you hold a license to operate a facility licensed by the Pennsylvania Department of Human Services (DHS).  

There are two changes to the Civil Rights Compliance process. First, there is a new Civil Rights Compliance form when submitting a new licensing application and a new Civil Rights Compliance attestation form when submitting a licensing renewal application. Second, the process of submitting the form has changed.

Entities seeking a new license will utilize a Civil Rights Compliance (CRC) form (HS 2126). This form must be included in the packet submitted as part of any new license request. The new application, supporting documents and CRC form must be emailed to the DHS office that issues your license, the email address can be found in the chart below. Entities licensed by OCDEL or ODP who use CLS or PELICAN to submit new applications must submit the form by email.  The CRC forms are not part of the electronic CLS/PELICAN new application process. The CRC form for new applications can be found at: App for License (pa.gov)  or https://www.dhs.pa.gov/providers/Clearances-and-Licensing/Pages/App-for-License.aspx

For licensing renewals, a licensee will now submit a CRC Attestation form (HS 2125).  The Attestation form must be submitted as part of a renewal licensing application. The renewal notice will still be sent out 130 days prior to expiration.  The renewal application and Attestation must be emailed to the DHS office that issues your license; the email address can be found in the chart below. Entities licensed by OCDEL or ODP who use CLS or PELICAN to submit renewal applications must submit the attestations by email.  The attestations are not part of the electronic CLS/PELICAN renewal application process. The CRC form for can be found at  App for License (pa.gov) or https://www.dhs.pa.gov/providers/Clearances-and-Licensing/Pages/App-for-License.aspx

he DHS Bureau of Equal Opportunity currently issues you a letter verifying that you are in compliance with applicable civil rights laws.  With the new process, a letter from BEO will no longer be sent out to licensed entities. Instead, the issuance of the new license or renewal license will indicate that your CRC form or Attestation form submission was approved. If there are issues/questions on the submitted CRC or Attestation form, a staff member from DHS will contact you.  

Note: At the discretion of program offices you can amend the communication to allow legal entities to submit an attestation form for multiple locations and include attachment of additional locations.

If your license is issued by…	Submit your application AND your CRC form (if new license)  or  CRC Attestation (if license renewal) to:
The Bureau of Adult Residential Licensing	RA-PWLICADBHSLPRO@pa.gov
The Office of Children, Youth, and Families	RA-PWLICADOCYFPRO@pa.gov
The Office of Mental Health and Substance Abuse Services	RA-PWLICADOMHSASPRO@pa.gov
The Office of Developmental Programs*	RA-odplicensing@pa.gov
The Office of Child Development and Early Learning*	Child care providers should include their MPI number in the subject line and email the appropriate regional office:Northeast Region:  RA-ocdelcertncscrant@pa.gov Central Region:  RA-ocdelcertnchbg@pa.govCounties:  Dauphin, Cumberland, Lancaster, York, Adams, Lebanon and York                            RA-ocdelcertncsel@pa.govCounties:  Snyder, Perry, Juniata, Centre, Mifflin, Tioga, Lycoming, Northumberland, Union and Clinton South Region:  RA-ocdelcertse@pa.gov
	Western Region:  RA-ocdelcertwpittsbu@pa.govCounties:  Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington and Westmoreland                                       RA-ocdelcdertwhollid@pa.govCounties:  Bedford, Blair, Cambria, Franklin, Fulton, Huntingdon and Somerset

*Licensees who use CLS or PELICAN to submit renewal applications must submit the attestations by email.  The attestations are not part of the electronic CLS/PELICAN renewal application process.

The new process is effective on Monday, August 22, 2022.  Existing licensees and applicants must begin following the new process on or before that date.   

If you have any questions about the new process, please contact the applicable DHS office using the emails shown above. Thank you for your commitment to protecting the rights of Pennsylvania’s most vulnerable citizens.