Information Collection

Assurance of Compliance Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination...

IC 22632 under ICR 200902-1870-001 · OMB 1870-0503.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1870-0503 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Assurance of Compliance Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination...	Form and Instruction
Assurance of Compliance-Civil Rights Certificate OCR Compliance Form 1870-0503.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Assurance of Compliance Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination...

Agency IC Tracking Number:

03918

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 100.4 34 CFR 104.5 34 CFR 106.4 34 CFR 108.8 34 CFR 110.23

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Assurance of Compliance-Civil Rights Certificate	OCR Compliance Form 1870-0503.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	50	-16,950	17,000
Annual IC Time Burden (Hours)	17	-5,650	5,667
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.