OMB Control Number 0945-0008
Exp. Date: 12/31/2022
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
ASSURANCE OF COMPLIANCE
Under the Paperwork Reduction Act of 1995, as amended, and 5 C.F.R. § 1320.5(b)(2)(i), persons are not required to
respond to this collection of information unless it displays a currently valid OMB control number. The OMB control number
for this collection is 0945-0008. In lieu of completing this hard copy form and mailing it in, the Applicant may provide this
assurance via the U.S. Department of Health and Human Services’ Assurance of Compliance online portal at
https://ocrportal.hhs.gov/ocr/aoc/instruction.jsf.
ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL
RIGHTS ACT OF 1964, SECTION 504 OF
THE REHABILITATION ACT OF 1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972,
THE AGE DISCRIMINATION ACT OF 1975, SECTION 1557 OF THE PATIENT PROTECTION AND
AFFORDABLE CARE ACT, AND FEDERAL CONSCIENCE AND ANTI-DISCRIMINATION LAWS
*With respect to compliance with 45 C.F.R. Part 88, the signatory is providing assurance of compliance with such
Part to the extent it is in effect during the term of the award. Consistent with applicable court orders, the version of
Part 88 in effect as of December 2, 2019, is found at 76 Fed. Reg. 9,976-77 (February 23, 2011).
The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants,
loans, contracts, property, discounts
or other Federal financial assistance from the U.S. Department of Health
and Human Services.
THE
APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH:
1.
Title VI of the Civil Rights Act of 1964, as amended (codified at 42 U.S.C. § 2000d et seq.), and all
requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services
(45 C.F.R. Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in
the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be
denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the
Applicant receives Federal financial assistance from the Department.
2.
Section 504 of the Rehabilitation Act of 1973, as amended (codified at 29 U.S.C. § 794), and all requirements
imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part
84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified
individual with a disability in the United States shall, solely by reason of her or his disability, be excluded from
participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for
which the Applicant receives Federal financial assistance from the Department.
3.
Title IX of the Education Amendments of 1972, as amended (codified at 20 U.S.C. § 1681 et seq.), and all
requirements imposed by or pursuant to t he Regulation of the Department of Health and Human Services (45
C.F.R. Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States
shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected
to discrimination under any education program or activity for which the Applicant receives Federal financial
assistance from the Department.
4.
The Age Discrimination Act of 1975, as amended (codified at 42 U.S.C. § 6101 et seq.), and all requirements
imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 91),
to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis
of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any
program or activity for which the Applicant receives Federal financial assistance from the Department.
5.
Section 1557 of the Patient Protection and Affordable Care Act, as amended (codified at 42 U.S.C. § 18116),
and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human
Services (45 CFR Part 92), to the end that, in accordance with Section 1557 and the Regulation, no person
in the United States shall, on the ground of race, color, national origin, sex, age, or disability be excluded
from participation in, be denied the benefits of, or be subjected to discrimination under any health program or
activity for
which the Applicant receives Federal financial assistance from the Department.
