US-T2 Consequential-Decision and Discrimination Impact Assessment
Verification required. This is a working template, not a regulator-approved form. Where it names an instrument or a date, the claim comes from secondary sources or from memory of the law and is a pointer to check. This is not legal advice.
How to use: This is a blank form. Copy it and fill in the empty cells and blanks for your system. To copy it, follow the "Suggest an edit to this page" link in the footer to reach its Markdown source.
Wiki controls: AI-CTRL-037, AI-CTRL-023, AI-CTRL-041. For employment, credit, housing, healthcare, education, insurance and legal-service decisions. The legal standards (disparate impact, adverse action notices) are [Recalled]; get counsel's input.
| Field | Entry |
|---|---|
| System ID; decision type | |
| Role (developer or deployer) | |
| States of impact | |
| Protected classes considered | |
| Data used; proxies for protected attributes |
Testing
| Test | Method | Threshold | Result | Date |
|---|---|---|---|---|
| Selection-rate comparison across groups | ||||
| Error-rate comparison | ||||
| Less discriminatory alternative considered | ||||
| Validation of job-relatedness or business-relatedness |
Notices and process
| Item | Done | Evidence |
|---|---|---|
| Pre-decision notice | ||
| Adverse action reasons available | ||
| Human review and appeal route | ||
| Opt-out where required | ||
| Records retention |
Decision
Proceed / proceed with conditions / stop. Owner: __ Legal sign-off: _ Date: Next review: ___