Applicant subjected receives 2026

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The document is an Assurance of Compliance with various civil rights laws, including Title VI of the Civil Rights Act, Section 504 of the Rehabilitation Act, Title IX of the Education Amendments, and the Age Discrimination Act. It outlines the Applicant's commitment to prevent discrimination based on race, color, national origin, disability, sex, and age in programs receiving federal financial assistance from the U.S. Department of Health and Human Services. The assurance is a condition for receiving such assistance and is binding on the Applicant and its successors.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date in the designated field at the top of the form. This is crucial for record-keeping purposes.
In the signature section, ensure that an authorized official signs the document. This confirms commitment to compliance with federal regulations.
Next, print or type the name and title of the authorized official in the provided fields below the signature line.
Fill in the name of your healthcare facility, followed by its street address, city, state, and zip code. Accurate information is essential for proper identification.
Finally, review all entries for accuracy before submitting. Once completed, you can easily download or share your filled form directly from our platform.

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