Form VA Form 20-8734 VA Form 20-8734 Equal Opportunity Compliance Review Report

OMB Approved No. 2900-0455
Respondent Burden: 45 minutes

EQUAL OPPORTUNITY COMPLIANCE REVIEW REPORT
PRIVACY ACT INFORMATION: The information requested in this report is required by law (Title VI of the Civil Rights Acts of 1964, Title IX of the Education Amendments of
1972, Section 504 of the Rehabilitation Act of 1973, The Age Discrimination Act of 1975, and Executive Order 12250).
The information collected is used to assure that VA Federally-funded programs are in compliance with equal opportunity laws. If the information on the form were not
collected VA would be unable to carry out its withdrawal of rights responsibilities mandated by law. Your obligation to respond is required in order to obtain or retain benefits.
Failure to report may result in withdrawal of Federal Financial Assistance. Responses may be disclosed outside VA only if the disclosure is authorized under the Privacy Act,
including the routine uses identified in VA system of records, 37VA27, VA Supervised Fiduciary and Beneficiary Records - VA, published in the Federal Register.
RESPONDENT BURDEN: We need this information to assure that VA Federally-funded programs are in compliance with equal opportunity laws. We estimate that you will
need an average of 45 minutes to review the instructions, find the information and complete this form. VA cannot conduct or sponsor a collection of information unless a valid
OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on
the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send
comments or suggestions about this form.

NOTE - An asterisk (*) indicates corrective actions or more explanations will be necessary. (Explain in Item 61)

SECTION I - PREPARATION FOR ONSITE REVIEW
1. LOCATION OF FIELD STATION

3. DATE OF PRIOR CONTACT

2. NAME AND TITLE OF PERSON CONTACTED IN FACILITY (If prior contact was made)

4. NAME OF PERSON CONDUCTING VISIT

5. DATE OF VISIT

6. NAME AND ADDRESS OF FACILITY

7. HAVE EO COMPLAINTS BEEN FILED AGAINST THE FACILITY WITHIN THE LAST FIVE YEARS?
(If "YES," explain here
YES
NO or in Item 61)
9. SIGNED VA FORM 20-8206 (check appropriate box)
10. VA FORM 20-4274 (Check appropriate box)
ON FILE
NOT ON FILE

OBTAINED DURING VISIT

8. NO. OF VETERANS OR
BENEFICIARIES

ON FILE

OBTAINED DURING VISIT

NOT ON FILE

UPDATED DURING VISIT

SECTION II - ONSITE VISIT/GENERAL INFORMATION
11. NAME AND TITLE OF PRINCIPAL FACILITY OFFICIAL INTERVIEWED

12. NAME AND ADDRESS OF PARENT INSTITUTION (If applicable)

13. OTHER FEDERAL PROGRAMS IN WHICH FACILITY PARTICIPATES
A. TITLE OF FEDERAL PROGRAM

14A. NUMBER OF HANDICAPPED
PARTICIPANTS

B. NO. OF PARTICIPANTS

14B. CATEGORIES OF HANDICAP

15. DOES THE FACILITY HAVE A GRIEVANCE OR APPEAL PROCEDURE FOR APPLICANTS AND PARTICIPANTS WHO ALLEGE DISCRIMINATION
BECAUSE OF RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP, OR AGE? (Explain in Item 61)
YES
NO

SECTION III - ADMISSIONS
16. ARE THERE PREREQUISITES THAT LIMIT ADMISSION ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP
OR AGE?

YES

NO

*

17. DOES THE FACILITY REQUIRE A PHOTOGRAPH OR OTHER PRE-ADMISSION INFORMATION THAT WOULD IDENTIFY THE
APPLICANT’S RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP, OR AGE?
18. GIVE REASON FOR REQUIREMENT OF PHOTOGRAPH

19. EXPLAIN THE REQUIREMENT(S) FOR OTHER ADMISSION IDENTIFICATION

SECTION IV - RECRUITMENT
20. DESCRIBE TYPES OF RECRUITING AND ADVERTISING TECHNIQUES USED

21. IF RESTRICTED METHODS OF RECRUITING AND ADVERTISING ARE USED, EXPLAIN WHY

22. DO CATALOGS, BROCHURES, ADVERTISEMENTS, AND OTHER PUBLICITY MATERIALS USED BY THE FACILITY REFLECT EQUAL
ACCESS BY ALL INDIVIDUALS WITHOUT REGARD TO RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP OR AGE?
VA FORM
JUL 2007

20-8734

EXISTING STOCK OF 20-8734, JAN 1998,
WILL BE USED.

*

N/A

NOTE - An asterisk ( *) indicates that corrective actions or more explanations will be necessary. ( Explain in Item 61)

YES

NO

SECTION V - FINANCIAL ASSISTANCE
23. DOES THE FACILITY OFFER FINANCIAL ASSISTANCE?

*

24. NUMBER OF PARTICIPANTS RECEIVING FINANCIAL ASSISTANCE
A. HANDICAPPED

B. MINORITY GROUP

C. MALE

D. FEMALE

SECTION VI - TRAINING AND ACTIVITIES
25. DO PARTICIPANTS TAKE PART IN ALL COURSES/TRAINING OFFERED BY THIS FACILITY WITHOUT RESTRICTIONS DUE
TO RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP, OR AGE?
26. ARE HANDICAPPED PARTICIPANTS’ ACTIVITIES, FUNCTIONS, OR SERVICES SEPARATE FROM THOSE OF
NON-HANDICAPPED PARTICIPANTS?

*
*

27A. DOES TRAINING INCLUDE CUSTOMER SERVICE?

27B. IF TRAINING INCLUDES CUSTOMER SERVICE, DO ALL PARTICIPANTS SERVE ALL CUSTOMERS WITHOUT REGARD TO
RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP, OR AGE?
28. HAS THE FACILITY INCLUDED ANY AIDS, BENEFITS OR SERVICES, MODIFIED ACADEMIC REQUIREMENTS, OR MADE OTHER
MODIFICATIONS TO PROGRAMS OR ACTIVITIES FOR THE PURPOSE OF ASSISTING QUALIFIED HANDICAPPED
PARTICIPANTS?
29. ARE FACILITY SPONSORED ACTIVITIES OPEN TO ALL PARTICIPANTS WITHOUT REGARD TO RACE, COLOR, NATIONAL
ORIGIN, SEX, HANDICAP, OR AGE?

*
*

*
*

30. WHAT METHODS ARE USED BY THE FACILITY TO VERIFY THAT PROGRAMS, SERVICES, OR EXTRACURRICULAR ACTIVITIES NOT OPERATED BY THE
FACILITY ARE PROVIDED EQUALLY TO PARTICIPANTS REGARDLESS OF RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP, OR AGE?

31. HAS THE FACILITY OBTAINED A WRITTEN STATEMENT OF ASSURANCE OF COMPLIANCE WITH EO LAWS FROM SUBRECIPIENTS?

*

SECTION VII - HOUSING
32. DOES THE FACILITY PROVIDE HOUSING ASSISTANCE TO ITS PARTICIPANTS WITHOUT REGARD TO RACE, COLOR, NATIONAL ORIGIN,
SEX, HANDICAP, OR AGE?

*

33. IF HOUSING IS AVAILABLE AND ACCESSIBLE TO HANDICAPPED PARTICIPANTS, IS IT COMPARABLE TO HOUSING
PROVIDED FOR NONHANDICAPPED PARTICIPANTS?

*

SECTION VIII - PLACEMENT ACTIVITIES
34. DOES THE FACILITY OFFER PLACEMENT ASSISTANCE?

35. ARE THERE ANY AGE REQUIREMENTS USED IN PLACEMENT ASSISTANCE?

*

36. DO THE PLACEMENT RATES REFLECT A REASONABLY EQUITABLE DISTRIBUTION OF PLACEMENT AMONG THE PROTECTED GROUP
PARTICIPANTS VS. THE MAJORITY GROUP PARTICIPANTS? IF "NO," HOW DOES THE RECIPIENT EXPLAIN THE DIFFERENCE?

*

37. HOW ARE PARTICIPANTS INFORMED OF PLACEMENT OPPORTUNITIES?

38. ARE COUNSELING SERVICES PROVIDED TO PARTICIPANTS ON AN EQUAL BASIS REGARDLESS OF RACE, COLOR,
NATIONAL ORIGIN, SEX, HANDICAP, OR AGE?
39. DOES THE FACILITY HONOR EMPLOYMENT REFERRAL REQUESTS WHICH DESIGNATE A PREFERENCE FOR PERSONS OF A SPECIFIC
RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP, OR AGE?

*
*

SECTION IX - EMPLOYMENT
40. NUMBER OF PERSONS EMPLOYED BY FACILITY

41. IF THE FACILITY EMPLOYS 15 OR MORE PERSONS, DOES THE FACILITY HAVE AN EO REPRESENTATIVE?

YES
NO (If "Yes," give the name of the representative)
42. DOES THE FACILITY ADMINISTER OR OPERATE ANY TEST OR HAVE ANY CRITERION FOR EMPLOYMENT OPPORTUNITIES WHICH HAS
AN ADVERSE EFFECT ON THE BASIS OF SEX, HANDICAP, OR AGE?

*

43. DOES THE FACILITY HIRE ON A NONDISCRIMINATORY BASIS?

*

44. DOES THE FACILITY ADVERTISE FOR OR RECRUIT APPLICANTS FOR EMPLOYMENT?

45. IDENTIFY METHODS OF RECRUITING AND ADVERTISING

46. HAS THE FACILITY ENCOUNTERED ANY PROBLEMS RELATIVE TO SEX, AGE, OR HANDICAP WHILE RECRUITING FOR OR PROVIDING
EMPLOYMENT SERVICES TO APPLICANTS?

*

47. ARE THERE DIFFERENCES IN EMPLOYMENT RATES BETWEEN THE PROTECTED GROUP PARTICIPANTS VS. MAJORITY GROUP
PARTICIPANTS? IF "YES," HOW DOES THE RECIPIENT EXPLAIN THE DIFFERENCES?

*

N/A

NOTE - An asterisk (*) indicates that corrective actions or more explanations will be necessary. (Explain in Item 61)
48. DOES THE RECIPIENT DIFFERENTIATE BETWEEN PROTECTED GROUP PARTICIPANTS AND MAJORITY GROUP PARTICIPANTS IN JOB
ASSIGNMENTS, TRAINING, PROMOTIONS, AWARDS OR LAYOFFS? IF "YES," HOW DOES THE RECIPIENT EXPLAIN THE NEED FOR
DIFFERENTIATION?
49. DOES THE RECIPIENT SEGREGATE OR CLASSIFY APPLICANTS AND EMPLOYEES ON THE BASIS OF SEX, AGE, OR HANDICAP IN ANY
WAY THAT COULD ADVERSELY AFFECT THEIR EMPLOYMENT OPPORTUNITIES OR STATUS?
50. DOES THE FACILITY REQUIRE PREEMPLOYMENT MEDICAL EXAMINATIONS?

YES
*

NO

N/A

*
*

SECTION X - INTERVIEWS WITH APPROPRIATE PARTICIPANTS AND INSTRUCTORS
51. REASON FOR NOT CONDUCTING INTERVIEWS WITH APPROPRIATE PARTICIPANTS AND/OR INSTRUCTORS

SECTION XI - TOUR OF FACILITY
52. ARE CLASSROOMS, RESTROOMS, AND AREAS FOR TRAINING, DINING, LOUNGING, WORK, ETC., COMPARABLE AND
ACCESSIBLE REGARDLESS OF RACE, COLOR, NATIONAL ORIGIN, SEX, HANDICAP, OR AGE?

*

53. IS THE VA EQUAL OPPORTUNITY POSTER DISPLAYED IN A CONSPICUOUS LOCATION?

*

54. DID THE RECIPIENT EXHIBIT A COPY OF THE VA’S EQUAL OPPORTUNITY GUIDELINES?

*

SECTION XII - EXIT INTERVIEW
55. IF NONCOMPLIANCE WAS FOUND, WAS AN AFFIRMATIVE ACTION AGREEMENT OBTAINED? (If "Yes," attach copy)

*

SECTION XIII - COMPLIANCE STATUS OF FACILITY
56A. ARE THERE ANY QUESTIONS OR PROCEDURES THAT NEED REEXAMINATION?
YES

56B. DATE FOR FOLLOW-UP REVIEW

NO ("If "YES," complete in Item 61)

57. THE FACILITY IS IN COMPLIANCE WITH TITLE VI OF CIVIL RIGHTS ACTS OF 1964

YES

NO

YES

NO

YES

NO

YES

NO

58. THE FACILITY IS IN COMPLIANCE WITH TITLE IX OF THE EDUCATION AMENDMENTS OF 1972

59. THE FACILITY IS IN COMPLIANCE WITH SECTION 504 OF THE REHABILITATION ACT OF 1973

60. THE FACILITY IS IN COMPLIANCE WITH THE AGE DISCRIMINATION ACT OF 1975

61. REMARKS (If additional space is required use reverse)

62A. SIGNATURE OF PERSON WHO CONDUCTED THE ONSITE VISIT

62B. DATE OF ONSITE VISIT