Civil Rights Certificate - State, Local and Tribal Governments

Assurance of Compliance - Civil Rights Certificate

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

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:

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 %

	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

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.