Civil Rights Impact Analysis
Rev. 3/17
A Civil Rights Impact Analysis is required before closing or relocating a local agency. This template
provides guidance on the information to be gathered. It should be provided to USDA-FNS at least
60 days prior to closure or relocation. Additional pages may be included if needed.
State Agency:
Kansas Nutrition & WIC Services
Local Agency/Clinic Name:
Current Location New Location
1. When will the move occur?
2. Distance from the old clinic to the new clinic?
3. Amount of advance notice to participants?
How will clients be notified?
4. Will the clinic remain non-smoking?
Provide assurance
Yes.
Kansas state law prohibits smoking in public
buildings.
5. Demographic assessment comparing old and
new location. Include available information.
Demographic map
Racial composition of affected neighborhoods
Census data
6. Is the new location in an area where at risk
populations or low income housing are
located?
7. Is the new location accessible for clients with
disabilities?
Is public transportation also available?
8. Participation
By category
Women
Infants
Children
By race/ethnicity
White
American Indian/Alaska native
Hispanic/Latino
Asian
Black/African American
Native Hawaiian Pacific Islander
Average participation for last 6 months
9. Availability of other community resources
including other local agencies
10. Consideration of Affirmative Action Plan
Information
The relative position of the area or special
Population served in the Affirmative Action
Plan
How much of the current need is met at each
priority level and participant category?
The potentially eligible individuals in the area
All areas and all participant priority levels in
Kansas are currently being served.
The current need is being met at each priority
level and participant category.
It is estimated that there are ____ potentially
eligible individuals in the county.
11. Place in local agency priority system
All local agencies in Kansas are equally placed
with regard to priority.
12. Public notification
What methods are being used (such as radio,
phone calls, text messages, flyers etc.?)
13. Cost effectiveness
14. Participant Access:
Describe the State agency’s Participant Access
Criteria
Are there access issues for the new clinic
location?
Are there access issues for the availability of
authorized vendors such as geographic barriers?
There are no limitations to access. All eligibles who
apply at this location are assessed and certified
according to WIC policies and procedures.
Signature of reviewer
Date
As of date for assessment
click to sign
signature
click to edit
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