Information Collection

Title VI Assurances

IC 247260 under ICR 202206-1505-004 · OMB 1505-0271.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0271 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Title VI Assurances	Form and Instruction
Title VI Assurances Title VI Assurance_5-7-21.docx	Form and Instruction
Title VI Assurances Title VI Assurance_5-7-21.docx	Form and Instruction

IC Title:

Title VI Assurances

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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	Title VI Assurances	Title VI Assurance_5-7-21.docx		Yes	Yes	Fillable Fileable

Line of Business: Disaster Management

Subfunction: Disaster Repair and Restore

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,050

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	5,050	5,050
Annual IC Time Burden (Hours)	2,525	2,525
Annual IC Cost Burden (Dollars)	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.