Form EDI Form EDI Form EDI Form

Excellence in Disability Inclusion Award
Nomination Form Instructions
Public Burden Statement: According to the Paperwork Reduction
Act (PRA) of 1995, as amended, no persons are required to respond
to a collection of information unless such collection displays a
valid OMB control number. The public reporting burden for this
information collection is estimated to be 21.5 hours. If you have
comments regarding the estimated reporting burden, or suggestions
for reducing the burden, please send them to the Office of Federal
Contract Compliance Programs (OFCCP), Division of Policy and
Program Development, 200 Constitution Avenue, N.W., Room C-3325,
Washington, D.C. 20210 and reference OMB Control Number
1250-XXXX. This program is conducted under the authority of
Executive Order 11246, as amended, Section 503 of the Rehabilitation
Act of 1973, as amended, and the Vietnam Era Veterans’ Readjustment
Assistance Act of 1974, as amended. Please do not send nomination
packages to this address. All nomination packages must be emailed to
OFCCP at the email address advertised on the agency’s website.
To be considered for the award, contractors must meet the
below eligibility criteria:
1. The nominated contractor establishment (i.e., the facility or
location of the parent company or firm) meets the written
affirmative action program (AAP) jurisdictional threshold and
has current AAPs for Section 503 and EO 11246, and an AAP for
Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as
amended (VEVRAA), if applicable.
2. The nominated contractor establishment has implemented
equal employment opportunity and affirmative action programs
under Section 503 and EO 11246, and VEVRAA, if applicable.
3. The nominated contractor establishment has no unresolved
violations of Section 503 and EO 11246, and VEVRAA,
if applicable, as identified during OFCCP compliance
evaluations or complaint investigations. Unresolved
issues include violations that are in litigation, violations
in an open conciliation agreement, and violations in a
pending compliance review. A complaint filed against the
nominated contractor establishment during the application
process will not disqualify a contractor establishment from
applying. However, if the complaint is substantiated and the
establishment is found at fault after receiving the award,
OFCCP will revoke the award.
4. The nominated contractor establishment has no adverse
decisions by a court, Administrative Review Board (ARB), or
Administrative Law Judge (ALJ) related to violations of Section
503, EO 11246, VEVRAA, or the Americans with Disabilities Act
(ADA) within the last three years.
All pages of the nomination package must be clear, readable,
and typed. No handwritten material will be accepted. All
statements of support, descriptions, and any other material

submitted in the nomination package must be typed, on
size 8.5” X 11” pages, one-sided, double-spaced in Times
New Roman, 12 point font. No other formats or styles will
be accepted. Packages with items that exceed established
page limits or do not comply with the requirements and
instructions will not be considered. Incomplete nomination
packages will also not be considered. Please note that only
the first submission from each contractor establishment will
be accepted. Consequently, if a contractor establishment first
submits an incomplete nomination package and later submits
a complete package, only the first submission will be reviewed
and will be rejected as incomplete. All statements of support
must be signed by the persons submitting them.
Information provided in the nomination package, including
the statements of support, may only be submitted in a
manner that complies with any applicable privacy laws. No
information submitted as part of the nomination package will
be used or shared for the purposes of compliance evaluation
or any enforcement action. All nomination packages must
be emailed to OFCCP at the email address advertised on the
agency’s website. All parts of the nomination package must be
submitted in one email submission.
The contractor must submit items 1 to 9 below on the form
accompanying these instructions. Items 10 to 15 must be
sent as email attachments, along with the form.
1. Provide the name of the contractor firm or parent company,
and the name of the contractor establishment that is being
submitted for the award. Include the physical address (no
post office box addresses), and Employer Identification
Number (EIN number).
2. Provide the name, title, address, phone number, and email
address for the President or Chief Executive Officer (CEO) of
the contractor.
3. Provide the name, title, address, phone number, and
email address for the highest-ranking company executive
responsible for overseeing the equal employment opportunity
and affirmative action activities of the contractor.
4. Provide the name, title, address, phone number, and email
address for the point of contact for the nomination package.
5. Specify whether the contractor has a total workforce of more
than 100 employees or a workforce of 100 or fewer employees.
6. Specify whether the contractor applies the 7 percent
utilization goal to its job groups or to its entire workforce, if
the contractor has 100 or fewer employees, as prescribed by
OFCCP’s regulations at 41 CFR § 60-741.45.

7. S pecify whether the contractor establishment has received
this award during the previous two calendar years.

• The impact of the program or initiative on the voluntary
self-identification rates of applicants and employees, if any;
• The demonstrated support and engagement of contractor
employees, senior contractor officials and/or senior
contractor establishment officials for the program or
initiative;
• The impact of the program or initiative have on attaining
or demonstrating significant progress toward attaining
the aspirational 7 percent goal;
•T
 he effective use of technology in the program or initiative;
• The tangible and intangible benefits achieved because of
the program or initiative, and whether the performance
goals established for it were met;
• How the program or initiative contributed to the
establishment’s business success and what metrics were
used to measure success; and
• The challenges and barriers, if any, to successfully
implementing the program or initiative, how they were
overcome, and what key lessons learned would benefit
other contractors.

8. Specify if the contractor establishment is covered by a
moratorium through another OFCCP award within the last
two years.
9. Specify if the contractor or contractor establishment has a
disability-focused employee resource group (ERG).
10. The nomination package must include signed statements
of support from the contractor’s President or CEO and the
contractor’s highest-ranking company executive responsible
for overseeing the contractor’s equal employment opportunity
and affirmative action programs and initiatives. The
statements of support must not exceed two one-sided, typed,
double-spaced pages. Both statements of support must
include:
• a n acknowledgement that the nominated contractor
establishment agrees to participate in a video success
story on the importance of contractor compliance with
OFCCP’s regulations and that generally aligns with Office
of Disability Employment Policy’s (ODEP) broad goal of
developing and validating policy strategies and effective
practices for increasing employment opportunities for
individuals with disabilities;
• a n acknowledgment that the nominated contractor
establishment, if selected for an award, will work with
OFCCP and ODEP in a ”Year of Engagement,” a series
of relevant speaking engagements and appearances,
culminating in a two day Policy Academy;
• a certification that the nominated contractor
establishment is currently in compliance with its Section
503 and EO 11246 obligations, and VEVRAA if applicable,
and has no unresolved (i.e., violations that are in
litigation, violations in an open conciliation agreement,
and violations in a pending compliance review) OFCCP
violations; and
• a certification that the nominated contractor establishment
has no adverse decisions by a court, ARB, or ALJ related
to any of the below laws, and is not currently under
monitoring related to the same, for the three years prior
to its nomination package submission for any of the
following: Section 503 and EO 11246, VEVRAA, if applicable,
and Americans with Disabilities Act (as amended).
11. The nomination package must include a description of the
equal employment opportunity and AAP or initiative that
the contractor establishment implemented for individuals
with disabilities under Section 503. The description should
contain sufficient information on the below-listed items and
must not exceed 15 one-sided, typed, double-spaced pages.

12. Confirm that the nomination package includes a copy of the
establishment’s current year Section 503 AAP.
13. Confirm that the nomination package includes copies of data
from the previous AAP year: the results of the evaluation
of the effectiveness of outreach and recruitment efforts
41 CFR § 60-741.44(f); the contractor’s annual evaluation
of the utilization of individuals with disabilities, 41 CFR
§ 60-741.45(d)(3); documentation of the computations or
comparisons 41 CFR § 60-741.44(k), and documentation of all
actions taken to comply with the audit and reporting system
requirements described in 41 CFR § 60-741.44(h) including,
but not limited to, the results of the self-audits and the
remedial actions needed.
14. If a disability-focused employee resource group (ERG) exists
within the establishment or within the contractor, the
nomination package must include a signed statement of
support from the ERG.
15. Although not required, nomination packages may include
video hyperlinks and other information that demonstrate the
effectiveness of the contractor’s disability programs. Due to
email size limitations, it is preferred that large files such as
videos are submitted in hyperlink format, when available.

•T
 he description of the program or initiative, including
its duration and long-term sustainability, how it was
developed, its important components and activities, data
collection and analysis needs, and its budget or cost;
•T
 he performance goals that were established for the
program or initiative, how they were measured, and the
extent of management accountability for these goals;

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Excellence in Disability Inclusion Award
Nomination Form

Nomination Year
CONTRACTOR LOCATION AND CONTACT INFORMATION
1. Name of Contractor Firm/Parent Company
Name of Contractor Establishment
Physical Address
Establishment Employer Identification Number (EIN)
2. Name and Title of President or Chief Executive Officer (CEO)
Address
Phone

Email

3. Name and title of the highest-ranking company executive responsible for Equal Employment Opportunity/Affirmative Action
Address
Phone

Email

4. Name and title of point of contact for the award nomination package:
Address
Phone

Email

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GENERAL CONTRACTOR INFORMATION
5. Does the contractor have a total workforce of more than 100 employees?

Yes

No

6. If the contractor has 100 or fewer employees, does it apply the 7 percent utilization goal to its job groups or to its entire workforce?
(Check one)
Job groups
Workforce
7. Did the contractor establishment receive this award during the previous two calendar years?

Yes

No

(A “Yes” answer makes the contractor ineligible for this award.)

8. Did the contractor establishment receive, or is it otherwise covered by, a moratorium through another OFCCP award within the
last two calendar years? Yes
No
(A “Yes” answer makes the contractor ineligible for this award.)

9. Does the contractor or contractor establishment have a disability-focused employee resource group (ERG)?

Yes

No

NOMINATION CHECKLIST
This checklist is provided as a courtesy. It is the contractor’s responsibility to ensure that its nomination package is complete and accurate.
Please check off to confirm that the following are submitted in the nomination package:
10. Have you included signed statements of support from the President or CEO of the contractor and from the highest-ranking
company executive that is responsible for overseeing the contractor’s equal employment opportunity and affirmative action
programs and initiatives?
11. Have you included a description of the equal employment opportunity and affirmative action program or initiative that the
contractor establishment implemented for individuals with disabilities under Section 503?
12.

Have you included a copy of the establishment’s current year Section 503 AAP?

13. Have you included copies of all documentation and support data of the contractor’s previous year’s annual evaluation of
the effectiveness of outreach and recruitment efforts; annual evaluation of the utilization of individuals with disabilities;
documentation of data collection analysis; and the results of the self-audit and reporting?
14.

If applicable, have you included a statement of support from the disability-focused employee resource group (ERG)?

15. If applicable, have you included video hyperlinks or other information that demonstrates the effectiveness of the
contractor’s disability programs?

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