Information Collection

Civil Rights Certificate - State, Local and Tribal Governments

IC 22632 under ICR 201204-1870-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Civil Rights Certificate - State, Local and Tribal Governments	Form and Instruction
Assurance of Compliance-Civil Rights Certificate OCR Assurance Form - 2012 - 2-9-12 Final Version 2.docx	Form and Instruction

IC Title:

Civil Rights Certificate - State, Local and Tribal Governments

Agency IC Tracking Number:

4801

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 104.5 34 CFR 106.4 34 CFR 100.4 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 Assurance Form - 2012 - 2-9-12 Final Version 2.docx		No		Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 45

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	45	-5	50
Annual IC Time Burden (Hours)	15	-2	17
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.