FAX COVERSHEET

To:

SSA Office of International Affairs

f
From:

# ofpages iucluding cover sheet:

Re:

SF-181 Race

.13

& EthnicityForm

Attaehed Documents:
sF-18r
HJR T94
Motu Proprio
Pope's Apology to the Americas
Pope's Message of Peace
American Declaration on the Riglts of Indigenous Peoples

Fax:

l-877-385-0645

EPSON

wF-3640
Name

Fax

B(CEEI}YOUB YISIOH

A g$S;as o$ },r'h,n^*;o*o( AQt^"^s

: l- t77- 365 -oGq5
,SS

Recetpt No.fn.t"

Time

Type

Duration Paqes

Result

0r.3/0r.3

OK

010/013

Canceled

01:05

oo1/001

OK

r-2023,9,33,&&8:

0:L: a2

aLA

/ At4

KJE1

Send

18773850645

06:11

ata I

at4

OK

09:07

Send

1"8

850 64 5

05:46

013 / 013

OK

Nov.02

09:13

Send

L2023953888

07:08

013/01s

OK

L0?

Nov.02

09|22

Send

12023953888

03:44

006/0r.3

Error

107

Nov.02

09 -.27

Send

r.2 02 3 95s 88 8

04:10

013/013

OK

111

$o!r.03

,00: 5.0

Receive

234

"00:49

001

sa

!12

Nov. 03

00:52

Receive

Center
Center

234

00:57

001

OK

113

Nov,03

01:18

Send

12023953888

05:51

013 / 013

OK

114

Nov. 03

OL.,24

Send

187?3850645

05:46

013/013

OK

116

Nov.03

01:32

Send

12023953888

07 :00

1ta / 014

OK

115

Nov.03

0L:39

Send

18?7 3850 64 5

00:42

000/014

Error

11?

Notr.0,3,

0"1

:40

Send

r-8?73,.50,645

06:11

0L4 / 0L4

OK

117

Nov.03

01 :48

Send

187738504

00:00

000/014

Line

1,25

Nov.03

04

:51

Send

18773850645

05:50

013 / 013

OK

126

Nov.03

05:06

Send

1_2

:19

013/013

OK

133

Nov,03

22:,55

Send

r.2023953888

06:42

013/013

OK

134

Nov.03

23:O4

Send

18773850645

06:06

013/013

OK

100

Nov.02

08|29

Send

18773850645

101

Nov.02

08:41

Send

12023953888

102

Nov.02

08:47

Send

12 02

95388 e

10.3

I,Iov. 02

08:51

Ser:d

104

Nov.02

08

:59

105

Nov.02

106

77

023 953 88 8

05:47

07

1r81-

lilrv. 06

22:22

Selld

12,0233538,88

06:'0{

,0131O 13

r.8 3

Nov.06

22:28

Send

r.8773850645

06:00

013/013

OK

185

Nov.

64.

Send

r_8773850645

06:00

013/013

OK

184

Nov.06

Send

12023953888

00:00

000/013

Line

187

Nov.

06

22:48

Send

2023 95 38 88

06:. 43

aL3/ oL3

OK

189

Nov.06

23:05

Send

8773850645

06:04

01s/o1s

OK

191

!Iov.

O6

23:1&

Send

2023.953,&&8

0S-: 00

000 / 0r.3

fio

]-94

Nov.06

23:.23

Send

2023953888

07:,22

013 / 013

OK

L96

Nov.06

23:36

Send

87 73 85

645

06:06

13/ 013

OK

06

aE

Busy

Busy

l&$swer

U.S. Office of Personnel Management

Guide to Personnel Data Standards

ETHNICITY AND RACE IDENTIFICATION

{Please read the Privacy Act Statement and instructions before completing fonn.)
Social Security Number

Name (Last, First, Middle lnitial)

'il

n,rrn

.Dnn,r

L\e{ 3luAaA

in

Birthdate (Month and Year)

0.1 Jiqtq

A$dncy Use olily

Privacy Act Statement

Ethnictty and race information is requested under the authority of 42 U.S.C. Section 2000e-16 and in compliance with
the Office of Management and Budgefs 1997 Revisions to the Standards for the Classification of Federal Data on Race
and Ethnicity. Providing this information is voluntary and has no impact on your employment status, but in the instance
of missing information, your employing agency will attempt to identify your race and ethnicity by visual observation.

This information is used a$ necessary to plan for equal employment opportunity throughout the Federal govemment. lt
is also used by the U. S. Office of Personnel Management or employing agency maintaining the records to locate
individuals for personnel research or survey response and in the production of summary descriptive statistics and
analytical studies in support of the function for which the records are collected and maintained, or for related workforce
studies.

Social Security Number (SSN) is requested under the authority of Executive Order 9397, which requires SSN be used
for the purpose of uniform, orderly administration of personnel records. Providing this information is voluntary and failure
to do so will have no effect on your employment status. lf SSN is not provided, however, other agency sources may be
used to obtain it.
Specific lnstructions: The two questions below are designed to identiff your eftnicity and rae. Regardleas of your answerto
question 1, go to question 2.
Question

1.

Are You Hispanic or Latino? (A person of Cuban, Mexican, Puerto Rican, South or Central American, or other

Spanish culture or origin, regardless of race.)

ff Yes I

Question

2.

tto

Please select the racial category or categories with which you most closely identify by placing an

'}f

in the appropriate

box. Check as many as apply.

RACIAL CATEGORY
(Check as many as apply)

il

lme*can lndian or Alaska Native

DEFINITION OF CATEGORY

A person having origins in any of the original peoples of North and South America
(induding Central America), and wtro maintains tdbal affiliation or community
attachment.

fl

Rsian

A person having origins in any of ffre original peoples of the Far East, Southeast
Asia, or the lndian subcontinent induding, for example, Cambodia, China, lndia,
Japan, Korea, Malaysia, Pakistan, the Philippine lslands, Thailand, and Metnam.

fl

Black or African American

A person having origins in any of the black racial groups of Africa.

Native Hawailan orother Pacific lslander

A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or
otter Pacific lslands.

white

A person having origins in any of the original peoples of Europe, the Middle East, or
North Africa,
Standard Form 181
Revised August 2005
Previous editions not usable

42 U.S.C. Section 2000e-16

NSN 7540-01-09S-3446

+.trrfi!x!s?,

H. Res. 194

In the Hause of Representq,tiaes, fI. S.,

JUW 29, 2008.

Whereas millions of Africans and their deseendaut"s wer

enslaved in the IJnited States and the 13 Ameriean colonies frorn 1619 through 1865;

in Ameriea resembled no other form of involuntary servitude lsrown in history, as Afrieans were eaptured and sold at auetion like inanimate objects or ani-

Whereas slavery

mais;

Whereas Afoicans forced into slavery were brutalized, humili-

ated, dehumanized, and subjeeted to the indignity of

being stripped of their names and heritage;
Whereas enslaved families were torn apart after having been
sold separately foom one another;
Whereas the system of slavery and the visceral raeism against

persons of African deseent upon whieh it depended became entrenched in the Nation's social fabric;
Whereas slavery was not offieially abolished

until the passage

of the 13th Amendment to the United States Constitution in 1865 after the end of the Civil"War;
'Whereas

aft,er emaneipation from 246 years of slavery,

AfrL

ean-Arnerieans soon saw the fleeting political, soeial, and

eeonomie gains

they made during Reconstruetion

evis-

cerated hy virulent racism, lynchings, disenfranehisement,

Blaek Codes, and raeial segregation laws that imposed a

*igd system of offreially sanetioned racial segregation in
virtually all areas of llfe;
Whereas the system of de jure racial segregation known as

"Jirn Crow," whieh arose in certain parts of the Nation

following the Civil War to create separate and unequal
soeieties for whites and Aftiean-Amerieans, was a direet
result of the raeism against persons of African deseent
engendered by slavery;

of slavery in America, Federal aetion was required during the 1960s to

eliminate the dejure and defaeto system of Jim Crow
throughout parts of the Nation, though its vestiges still

Whereas a eentury after the official end

linger to this day;

to suffer from the eomplex interplay between slavery and Jim Crorn*long after

Wlhereas Afoican-Amerieans eontinue

both systems were formally atrolished-through enormous

damage and loss, both tangible and intangible, including
the loss of human dignity, the frustration of careers and
professional lives, and the long-terur loss of incorne and
opporhrnity;
Whereas the story of the enslavement and de jure segregation

of

African-Amerieans and the dehumaniaing atrocities

eommitted against them should not be purged from or
minimized in the telling of American history;
Whereas on July B, 2003, during a

trip to Goree Island,

Sen-

po*, President George'W. Bush aeknowledged slaveqy's eontinuing legaey in American life
egal, a former slave

and the need to eonfront that legaey when he stated that

slavery o'was .
one of the greatest erimes of history

. . . The racial bigotry

fed by slavery did not end with

slavery or with segregation. And many of the issues that

still trouble America have roots in the bitter experience
of other times. But however long the journey, our destiny
.is set: liberby and justice for all.";
Whereas President Bill Clinton also aehrowledged the deepseated problems eaused by the continuing legaey of rae-

ism against Afriean-Amerieans that began with slavery

when he initiated a national dialogue about raee;
Strhereas

a genuine apolog. is an important and

neeessary

first step in the proeess of raeial reeonciliation;

for eenturies of brutal dehumanization

and iqjustiees cannot erase the past, but eonfession of

Whereas an apolog,

the wrongs eommitted can speed racial healing and reconciliation and help Amerieans confront the ghosts of
their past;
Whereas the legislature of the Comnonwealth of Yirginia has

recently taken the lead in adopting a resolution offreially

expressing appropriate remorse for slavery and other
State legislatures have adopted or are considering similar
resolutions; and

it is important for this country, whieh legally reeognized slavery through its Constitution and its laws, to

Whereas

make a formal apology for slavery and for its suceessor,

Jim Crow, so that it ean

morre forward and seek rec-

onciliation, justiee, and harmony

Now, therefore, be it
Resolned,,

for all of its

citizens:

That the House of Representatives-

(1) aeknowledges that slavery is incompatible with

the basic founding prineiples recognized in the Declaration of Independence that all men are ereated equal;

(2) aeknoryledges the fundamental ir{ustiee, eruelt-v,

bmtality, and inlmmanity of slavery and Jim

Crorv;

(3) apologizes to Afriean Arnerieails on behalf of the

f+

people of the United States, for the rntorr$F eommitted

against them and their aneestors who suffered under

slar,'ery and Jinr. Crou,; antl

(4)

expresses

its

eommitment

to rectifi,- the lin-

gering eonsequenees of the misdeeds eommitted against

African. Amerieans under slarrery and Jirn Crow and to

stop the oceurrenee of humau rigltts violations in the future.

Attest:

. Cl,crk.

'.',

.{*

gZ?ftAB

Apostdic l-dter ls$ued Mofr, Proffo On the Jurisdction cf Jr.x*cid Au8rqitis cf \fficil City Sab in Crirnird Mders (11 Jdy 2Ot3) | Frarcis

APffiTOUC I.ETTER
ISSUED MOTU PROPRIO
OF THE S{'PREME PO$ITIFF

FRAI{GS
ON THE ]URISDICTICN OF JUDICTAL AUTHORITIES OF VATICAN CITY STATE

IN gRIMINAL MATTERS

In our times, thg common good is increasingfi threatened by transnational

organized crime, the improper use of tlre martets and of ttre economy, as well
as by terrorism.

It

is thelefore necessary for the internatbnal community to adopt adequate

legal insUunrenb to prevent and counter criminal adivities, by promoUng
international Judkial cooreration on criminal matte6.

In ratifying nunxerous intemational conventions in these ateas, and acting also

on behalf of VaUcan City State, the l-loly See has constan& rnaintained that
such agrcerfinB are effective means to pevent criminalactivities Uut ilrrcaten
human dgnrty, the common good and peace.
With a view to rcnewing the Apostolh See's commibnent to cooperate to these
ends, by means of this Apostolic Letter issued Motu Proprio, I establish that:
1, The cornpetent Judicbl Ar-dtprities

of Vatican City State shall abo exercise

penal jurtsdiction over:

a) crimes committed against the securtty, the fundamental interests

or the pakirnony of the HoV See;
b) crines rcfened to:
- in Vatican City State Law No. VIH, of 11 July 2013,
containirg Supplementary Nonns on Criminal Law
Matters;

- in Vatian fity State Law No. D(, of 11 July 2013,

containing Anrendments to the Criminal Code and the
Criminal Prqcedure Code;

when such crimes are committed by the persons

refered to in paragraph 3 below, in the exercise of
"

f'

their functions;

c) any other crime v*hose prosecuticn is required by an intemational

agreerEnt ratified by the Hoty see, if the perpetrator is phphally
present in the tenitory of vatican city,Shte ard has'not been
extradited.

judged pumuant to the

2. The crimes refened to in paragraph 1 are to be
criminal law in force in Vatican City SEte at the time of their commission,
without prcjudke. to the general principles of the legal slstem on the temporal
application of criminal laws. deemed
3. For the puryoses of Vat*can criminal law, tfrc following persons are
"public ofFrials":

a) members, offaials and prsonret of the varinus organs of the

Roman Curia and of the Institutions connected to it'
b) papal legates and diplomatk personnel of the He! See'
c) those persons who serve as representatives, managec or
directorS, as wellas pe6ons who even de facto manage or exercise
control over the entities directly dependent on the Holy see and
listed in the registry of canonicaliuridical persons kept by the
Govemorcte of Vatican CitY State;

d) any other perEon hoHing an administrative or judicial mandate in

the Holy See, permanent or temporary, paid or unpaid, irrespctive
of that Person's senioritY.

4. The jurisdiction refened to in paragraph 1 comprlses also the administrative

liability of juridical percolls arising from crimes, as regulated by Vatican
State laws.

City

provisions in
5. When the same matters are prosecuted in other states, the
force in vatican city state on concurent jurisdiction shall apply.

g2A2016

Apostdic Letter lssued Mc{u Proprio On the Jurisdiction d Judcid

Artnritie

cf \Hican City

SHe in Crimird Maters

5. The content of article 23 of Law No. CXD( of 21 November 1987, which

approves the Judicial Order of Vatican City State remains in force.
This

I decide

and establish, anything to the contri!ry notwithstanding.

I establish that this Apostolic Letter issued Motu

Proprio will be promulgated by

its publlcation in L'Gsenratore Romano, entering into force on

septembr

2013.
Given in Rome, at the Apostolic Palace, on
Pontificate.

ll

luly

2O13, the first of my

FRANCISCUS

O Copyright - Libreria Editrice VaUcana

(11

Jdy 2013) | Francis

3i
iii [-i 3es
=ad
.='=
,-

i,i

i6
d
=.9

6 +6I

q,*

5'Yo

5'=

iJ E
il
d Isc
dlE EE
ii

rD

ii
2

IB
?

s{=
Eg
0--'X
'.=lX ut

T'

6-r
cD

9.r

*H
ilil
jo
E6'
'-E

ii

8E P
'<o 1co
ad

ta D

,i
i

-A-<O

Ii
f,+{
.--.i

*6
J. (D

ad

=.e.
-N

8s

Eo 6'r
<o
<,o

-_J

!i

EA

ii

<o
oo

J
.,^+(o
'r!Jn-

ii
,I

,:

-$
c,-'
*-

<Q
=<

AE.
5a
.^ o

-l
=

o
B
O

^l
r
o
F

=.o
dt

a,
=
a=
g.

C);i'

.,
o
o
:l

<='
E,
oo
ox
Ju,

3 o'
r.-

R-J

OJ

A6

oo

(oJ

s.=
:Jo
@J
*--

+OJ
---.
A-U
.e5(D

q)

-r'

Ho

q
o
{r

r)

8E
Esr
OU,

oo
.-

6-

ial
w,v

J*
g>
_+
9(D
:aoJP

62
qs
fq

o-E

JIt

a
5
Q

1
o

go

8t
go

GI

6H I
c

g,

=
O

,=+
OU
f\

Z<D
$'rr
4^v

3s3
6.0
Ne

o)

;o.
Eo
oJ
=\;

o
a
ri+
o

g)

:,

A<

-t
N

o
-

o"

r\

d*

GI

l-

6\

o
-J
o
ca
'g
o
t,o
o
a
{r
o

le

:o

e.

ts
='
d
+
J=

-!o

-J

38_

+t' j,

J
\v-.
JA
(,

'Tl
-l
g

o
o

;6d
aE#

{ls16 cr!

T
o
to

{N

(,i)
f
JA

t5
l+

ta
I\

lr

lA
IE

=
d

l3

=
c

t6'

lc,

I13

lc

l=
l+

R
to

o
a
e

tot0)

i-6.

13

lo-

to)

tO

I=

lo
h

tr
kf,
ltx
r^
N/

to

l3

a
g
:-

cf,

o
o
@

cv
|.
J

?
=

*q)

{'a

Jo
o

o
CL
tl,

3
o
a
6'
=
o
o
=

F
C:
o
3

o
(rt

5P

1=
4S,
aZ

ue

n
fr
n
ID o i
m 6-5-{
m o-q)
=< rn
E
ftg{,
E a E-{
t
tI e=.3
eil m
g
fi.' nI
i3+

a;Egr= F= 3r g;

F ir; B E$

i=rs*s tH F* [$

E A;g E F8-

E $s
H Eei E

ts-

P.

klf

il
a.

o,
I

?B}
o
o
rg

Fi'

o
(l,
I

FF$gEg
E diif

F's[
B
F <. o-st
H1s'
P
6 Rrw
'

o
J

CI'

I
E
(D
o
E
o
tr)
I

il
I
U>

cn

oI
o
o
J
6'
(a

3I
o,
J

o
tr'

(3

SI*F*E ha na Ey
$ila$EEHil$n$g

Un

to
kn
KD

?3

ET
KD

lE,

(o

o
o

lo

fliHB+EHE3$EE

Ef

kt
lo)

e lT
Ft

:tr

Ef,

t:)

.*

g-

rJ--h<'

lT
B

tf
[a_

F HnE H
F
-*E's. H
E i=q"
E 88s bB a
E' Egil H- f
!'-o-o
d

' E

k)
tf,
lo

VLAJ

3ai=
= o-=.

95'*

@o6orH u

E$E
g$g
;+q
r= 6

B
I(D

n
h)'

t{
FI

E
=
E
o

Fr

l=
hD
tr
tf,-

h
l(D

8.

ll)
t3
ff,
li)

6
=

h,

fl
a

Ir3
13

hr

F
rl

P)

t=

aE:e[

E; i

#$i$f, HH
giHea dE

,Plr..ro@

E$x*i

"F

A$

[H

it .a

BF

+
A

=.
E

$EIEH$*$E

*v

O
E
.lc
6

.lE

fr

sEI
F='Q
*A
5(D
O)rr

:g
g-,L

;g
(o
o

*<

gr

o,

='(()
,dE.

3
II)

(o
g.

ge
rB*is
9Q=is, fi3

EEf*E .E

[+8.te' $3

rfaia
fr
"3
d=:
3E
-t:o

q
=

B'

il

IL

e%

The HIrv See

MESSAGE OF HIS HOLINESS

POPE FFIAI{CIS
FOR THE CELEBRATION OF THE

WORLD DAY OF PEACE

1 JANUARY 2C15

I.IO LOHGER SI-AYES, BUT BROTHERS AND SISTERS

1. At the baginning oJ this New Year, which we welcome as God's gracious gift to all humanity,

offer heantfelt wishes of peaoe to every lnan and uy*rylarr, to all tfre urryld's peoples a*d nations" to
heads of Sate ar*d goverr*rnen[ and to rdigious leaders" Xn doirq so, I pray for an end to \firals"

caffid

by luur*an assrlry, by epffi+nri*s past and pr*ent, and by

the derrastation wrcnryht by Ea&ra{ disasters" I pray mpecHly #rat, on ifre basis of our smfi}sn
calling to cooperate wtlh God and all people of good will for the advancement of harmony and
peace in the wodd, we may resist the temptation to act in a manner unwerthy of our humaniiy.
eorafiicfi* arud &ie great sufferirry

ln myllessage for Eeatre last year, I spoke of "fte desire for a ful{ life".. u&icfr indudes a longing
fonfratemfif,y udt!ic*: draracs us to felhnrship wtttr o&erc and enah&*s us to sae

ft*rn not

Es e*ernies

or rivals, hut as bnotltss amd efiSem to be awepted and ernbmce$-$,] $ince we ara by nature

ftruugtr ir*terp*rsonal relationsfiip* in*pired bv iustice

and love, it is fumdarnental for our lwnnam deueloprnen* tfiat our drgnff" treedcrfi and autonorny be
acil<nowbdged and respected. Trag*mliy, the growirq sosurge of,trrar?'s exp&oitaticn by rnam
gnavely#rmages&e Nfrfeof mn$ne.r*['sn and ourffitlir_ tofurgF frr#erperrcnal relatims marltd by
respect, iustice and tove. This ahminable phenomenon, which leadsto contemptforthe
fundamentaI {igffis of others and te tfw supp*wsfiorr of $ein Mo*r and dSnity, takee rfiany
forms. I $rould like briefly to consider these, so that, in the light of God's word, we can consider all
reNafionatr heings, n*eant {o.find fulfdrnent

rnen and wolnel?'*o krymrsilayes, &*rf bro{fiers ar*dsfufelt'"

Listenirw fo

fu's o{an for kurnanifu

-167 -

AG/RES. 2888 (XLVI-0/16)

AMERICAN DECLARATION ON TI{E RIGHTS OF INDIGENOUS PEOPLES

(Adopted at the third plenary session, held oa Juae 15, 2016)
+1

THE GENERAL ASSEMBLY,

RECALLING the cofltents of resolution AG/RES. 2867 (XLry-AIA), "Draft American

Declaration oa the Rights of Indigenous Peoples," as well as all the previous resolutions on this issue;
RECALL{NG also the "Declaration an the Rights of the lndigenous Peoples in the
Amsricas," document AGIDEC. 79 (XLff-O/l4), which reaflirrss that progress in promoting and
effectively protecting the righ* of the indigenous peoples of the Americas is a priority fot the
Organization of Americaa States;

RECOGNIZING the valuable suppos provided by the member states, observer states, the
organs, agencies, and entities of the Organization of American States for the process within the
Working Group to Prepare the Draft American Dsclaration on &e Rights of Indigenous Peoples;
RECOGNIZING as well the important participation of indigenous peoples ofthe Americas in
the process of proparing this Declaration; and

TAKING INTO ACCOUNT the significant contribution that the indigenous peoples of the
Americas have mads to humanity,

RESOLYES:
To adopt the following Draft Arnerican Declaration on the Rights of ladigenous People5"tl2r

2.

The United States remains committed to addressing the urgent issues of concem to indigenous peoples
across the Arnericas, including combating societal discriminatior against indigeaous peoples and..Canada reiterates its commitnent to a reaewed relationship with its Indigenous peoples, based on
reeognition of rights, respecf co-operation and parmership. Canada is now fully engaged" ...