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EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable) **SUPPORTING STATEMENT FOR PAPERWORK REDUCTION ACT SUBMISSION**  ASSURANCE OF COMPLIANCE

– CIVI L RIGHTS CERTIFI CATE EDICS Tracking and OMB Number: ( 4801 ) 1870 - 0503

Revised 0 4 /2 4 /2015 

### A. Justification 1. Explain the circumstances that make the collection of information necessary. I dentify any legal or administrative requirements that necessitate the collection. Attach a hard copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information , or you may provide a valid URL link or paste the applicable section . Please limit pasted text to no longer than 3 pages. Specify the review ty pe of the collection (new, revision, extension, reinstate ment with change, reinstatement without change) . If revised, briefl y specify the changes. If a rulemaking is involved, make note of the sections or changed sections, if applicable. This information collection is an extension of an existing collection. It is required by  T itle VIof the Civil Rights Act of 1964, as amended (Title VI), 42 U.S.C. 2000d, 34 C.F.R. 100.4 (prohibits discrimination on the basis of race, color or national origin by any program or activity

receiving Federal financial assistance , http://www.gpo.gov/fds ys/pkg/CFR - 2011 - title34 - vol1/pdf/CFR - 2011 - title34 - vol1 - sec100 - 4.pdf

);  T itle IX of the Education Amendments of 1972, as amended (Title IX), 20 U.S.C. 1681, 34 C.F.R. 106.4 (prohibits discrimination on the basis of sex in any education program or activity

receiving Federal financial assistance , http://www.gpo.gov/fds ys/pkg/CFR - 2010 - title34 - vol1/pdf/CFR - 2010 - title34 - vol1 - sec106 - 4.pdf

);  Section 504 of the Rehabilitation Act of 1973, as amended (Section 504), 29 U.S.C. 794, 34 C.F.R. 104.5 (prohibits discrimination on the basis of disability in any program or activity

receiving Federal financial assistance , http://www.gpo.gov/fds ys/pkg/CFR - 2011 - title34 - vol1/pdf/CFR - 2011 - title34 - v ol1 - part104.pdf

);  T he Age Discrimination Act of 1975, as amended, 42 U.S.C. 6101, 34 C.F.R. 110.23 (prohibits discrimination on the basis of age in any program or activity receiving Federal financial assistance , http://www.gpo.gov/fdsy s/pkg/CFR - 2010 - title34 - vol1/pdf/CFR - 2010 - title34 - vol1 - sec110 - 23.pdf ); and  T he Bo y Scouts of America Equal Access Act of 2001 (B oy Scouts Act), 20 U.S.C. 7905, 34 C.F.R. 108.8 (requires equal access for the Bo y Scouts of America and other designated youth groups to meet at public elementary and secondary

schools that receive funds made available through the Department of Education (Department) ,2

EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable) http://www.gpo.gov/fds ys/pkg/CFR - 2011 - title34 - vol1/pdf/CFR - 2011 - title34 - vol1 - part108.pdf

). These laws require that applicants for Federal financial assistance from the Department, as well as certain applicants for funds made available through the Department, submit an assurance of compliance to the Department assuring that they will compl y with these laws. 2. Indicate how, b y whom, and f or what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection. OCR uses the signed Assurance of Compliance

– Civil Rights Certificate forms to enforce Title VI , Title IX, Section 504, the Age Discrimination Act, and the Boy Scouts Act. Assurances are an efficient and effective tool for achieving compliance with the laws enforced b y OCR. Respondents only need to sign the Assurance of Complian ce – Civil Rights Certificate once; OCR keeps the signed assurances forms on file. 3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or f orms of information technology , e.g. permitting electronic submission of responses, and the basis for the decision of adopting this means of collection. Also describe any consideration given to using technology to reduce burden. At this time, OCR is unab le to accept electronic signatures. Accordingl y, OCR would collect the signed Assurance of Compliance forms b y traditional (paper) mail. The Assurance of Compliance

– Civil Rights Certificate form is available electronicall y on OCR’s website, and recipie nts may

print it out to reduce the burden of obtaining the form. 4. Describe ef

forts to identify

duplication. Show specificall y wh y an y similar information already available cannot be used or modified for use for the purposes described in Item 2 above. No other component of the Department collects these particular assurances of compliance with civil rights laws. 5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden. A small entity may be (1) a small business which is deemed to be one that is independently owned and operated and that is not dominant in its field of operation; (2) a small organization that is any not - for - profit enterprise that is3

EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable) independentl y owned and operated and is not dominant in its field; or (3) a small government jurisdiction, which is a government of a city, county, town, township, school district, or special district with a population of less than 50,000. This collection of information will not have a signi ficant economic impact on a substantial number of small businesses or other small entities. 6. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequentl y, as well as an y technical or l egal obstacles to reducing burden. If OCR does not collect signed Assurance of Compliance

– Civil Rights Certificate forms, OCR’s ability

to enforce Title VI , Title IX, Section 504, the Age Discrimination Act, and the Bo y Scouts Act will be affected. When entities accept Federal financial assistance from, or funds made available through, the Department, they are subject to these civil rights laws. By providing signed Assurance of Compliance

– Civil Rights Certificate forms, these entities agree to comply

with the civil rights laws and are put on notice that failure to comply with the civil rights laws could result in the loss of Federal financial assistance or funds made available through the Department. 7. Explain any

special circumstances that would cause an information collection to be conducted in a manner:  requiring respondents to report information to the agency more often than quarterl y;  requiring respondents to prepare a written response to a collection of information in fewer than 30 day s after r eceipt of it;  requiring respondents to submit more than an original and two copies of any document;  requiring respondents to retain records, other than health, medical, government contract, grant - in - aid, or tax records for more than three years;  in connect ion with a statistical survey , that is not designed to produce valid and reliable results than can be generalized to the universe of study;  requiring the use of a statistical data classification that has not been reviewed and approved b y OMB;  that includes a pledge of confidentiality that is not supported by

authority established in statute or regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or that unnecessarily impedes sharing of data with oth er agencies for compatible confidential use; or4

EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable)  requiring respondents to submit proprietary trade secrets, or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information ’ s confidentiality to the extent permitted by law. None of the eight special circumstances appl y to the Assurance of Compliance

– Civil Rights Certificate form. 8. As applicable, state that the Department has published the 60 and 30 Federal Register notices as required b y 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency

in response to these comments. Specificall y address comments received on cost and hour burden. Describe efforts to consult with persons outside the agency to obtain their views on the availability

of data, frequency

of collection, the clarity

of instruction and record keeping, disclosure, or reporting format (if an y), and on the data elements to be recorded, disclosed, or reported. Consultation with representatives of those from whom information is to be obtained or those who must compile records should occur at least once every 3 years – even if the collection of information activity is the same as in prior periods. There may be circumstances that may

preclude consultation in a specific situation. These circumstances should be explained. A 60 day notice was published in the Federal Register on February 18, 2015 ( 80 Fed. Reg. 32, pp. 8631 - 8632 ) . No public comments were received. A 30 day Federal Register notice w as published in the Federal Register. 9. Explain any

decision to provide any

pay ment or gift to respondents, other than remuneration of contractors or grantees with meaningful justification . No pay ments or gifts are made or provided to any respondent. 10. Describe an y assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy . If personally identifiable information (PII) is being collected, a Privacy Act statement should be included on the instrument. Please provide a citation for the Sy stems of Record Notice and the date a Privacy Impact Assessment was completed as indicated on the IC Data F orm . A confidentiality statement with a legal citation that authorizes the pledge of confidentiality should be provided. Requests for this information are in accordance with the following ED and OMB policies: Privacy

Act of 1974, OMB Circular A - 108

– Priva cy Act Implementation

– Guidelines and Responsibilities, OMB Circular A - 130 Appendix I

– Federal Agency5

EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable) Responsibilities for Maintaining Records About Individuals, OMB M - 03 - 22

– OMB Guidance for Implementing the Privacy Provisions of the E - Government Act o f 2002, OMB M - 06 - 15

– Safeguarding Personall y Identifiable Information, OM:6 - 104

– Privacy Act of 1974 (Collection, Use and Protection of Personally I dentifiable Information) . If the collection is subject to the Privacy Act, the Privacy

Act statement is de emed sufficient with respect to confidentiality . I f there is no expectation of confidentiality , simply state that the Department make s no pledge about the confidential ity of the data. T he Department makes n o pledge about the confidentiality of the data. 11. Provide additional justification for any questions of a sensitive nature, such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private. The justification should include the reasons why the agency

consid ers the questions necessary , the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent. There are no questions of a sensitive nature o n the Assurance of Compliance

– Civil Rights Certificate form. 12. Provide estimates of the hour burden of the collection of information. The statement should:  Indicate the number of respondents by affected public ty

pe (federal government, individuals or hou seholds, private sector

– businesses or other for - profit, private sector

– not - for - profit institutions, farms, state, local or tribal governments), frequency of response, annual hour burden, and an explanation of how the burden was estimated, including ide ntification of burden ty pe: recordkeeping, reporting or third party

disclosure. All narrative should be included in item 12. Unless directed to do so, agencies should not conduct special surveys to obtain information on which to base hour burden estimates . Consultation with a sample (fewer than 10) of potential respondents is desirable. If the hour burden on respondents is expected to vary widely because of differences in activity , size, or complexity , show the range of estimated hour burden, and explain the reasons for the variance. Generally, estimates should not include burden hours for customary and usual business practices.  If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in the ROCI S IC Burden Analy sis Table. (The table should at minimum include Respondent types, IC activity , Respondent and Responses, Hours/Response, and Total Hours)  Provide estimates of annualized cost to respondents of the hour burdens for collections of information, identifying and using appropriate wage rate categories. The cost of contracting out or paying outside parties for information collection6

EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable) activities should not be included here. Instead, this cost should be included in Item 14. Respondents only

need to sign the Assurance of Compliance

– Civil Rights Certificate form once. OCR keeps the signed Assurance of Compliance

– Civil Rights Certificate forms on file, and the signed forms apply to all future applications by the respondent s for Federal financial assistance from, or funds made available through, the Department. Once OCR has a completed Assurance of Compliance

– Civil Rights Certificate from a respondent, OCR does not ask that respondent again for another completed form. Oc casionall y, OCR receives requests for blank Assurance of Compliance

– Civil Rights Certificate forms. These requests could be made by, for example, a new charter school that has not previously

completed the form. Additionally , if OCR determines, during the course of investigating a complaint alleging a violation of a civil rights law, that a particular recipient of Federal financial assistance has not completed an Assurance of Compliance - Civil Rights Certificate form, OCR might require that the form be signed as part of a resolution agreement. In recent ye ars, OCR has received an average of 25 or so completed forms a year. Since OMB approval would cover 3 years, our best estimate for the total number of respondents is (3 years) x ( 25 respondents per year) = 75 . Because respondents only need to sign the Assurance of Compliance - Civil Rights Certificate form once, we have calculated a one - time, rather than an annual, hour burden for each respondent. The one - time hour burden in order to read and sign the Assurance of Compliance - Civil Rights Certificate form is estimated to be 20 minutes per respondent. Thus, the total number of estimated burden hours for collecting and reporting the information over the three ye ar period for which the Assurance of Co mpliance

– Civil Rights Certificate would be approved is estimated to be 25 burden hours: ( 75 recipients) x (.33 hours per recipient). The total annual hours, for one ye ar of the three year approval period, is estimated to be 8.33 burden hours: ( 22 state , local and tribal recipients x .33 hours per recipient) = 7.33 hours + ( 3 private sector recipients x .33 hours per recipient) 1 hour . 13. Provide an estimate of the total annual cost burden to respondents or record keepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14.)  The cost estimate should be split into two components: (a) a total capital and start - up cost component (annualized over its expected useful life); and (b) a total operation and maintenance and purchase of services component. The estimates should take into account costs associated with generating, maintaining, and disclosing or providing the information. Include descriptions of methods used to estimate major cost f actors including s ys tem and technology acquisition, expected useful life of capital equipment, the discount rate(s), and the time period over which costs will be incurred. Capital and start - up costs include, among other items, preparations for collecting information such as purchasing computers and software; monitoring, sampling, drilling and testing equipment; and acquiring and maintaining record storage facilities.7

EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable)  If cost estimates are expected to vary widel y, agencies should present ranges of cost burd ens and explain the reasons for the variance. The cost of contracting out information collection services should be a part of this cost burden estimate. In developing cost burden estimates, agencies may consult with a sample of respondents (fewer than 10 ), utilize the 60 - day pre - OMB submission public comment process and use existing economic or regulatory impact anal ys is associated with the rulemaking containing the information collection, as appropriate.  Generally , estimates should not include purchases of equipment or services, or portions thereof, made: (1) prior to October 1, 1995, (2) to achieve regulatory compliance with requirements not associated with the information collection, (3) for reasons other than to provide information or keep records for the government or (4) as part of customary

and usual business or private practices. Also, these estimates should not include the hourly

costs (i.e., the monetization of the hours) captured above in Item 12 Total Annualized Capital/Startup Cost: Total Annual Costs (O&M): Total Annualized Costs Requested: There is no cost burden to respondents. 14. Provide estimates of annualized cost to the Federal government. Also, provide a description of the method used to estimate cost, which should include qu antification of hours, operational expenses (such as equipment, overhead, printing, and support staff), and an y other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 1 2, 13, and 14 in a single table. The annual burden to the federal government from the OCR assurances form will be 10 minutes per form for approximately 25 forms per year, for a total of 4 hours and 10 minutes spent per ye ar. The employee who will process the forms is paid at an hourly rate of $ 16.55 /hour, so the total is 4.17 hours x $ 16.55 = $ 69.01 . Thus we anticipate the annual burden to the federal government to be $ 69.01 per year. The costs to the federal government are minimal.

15. Explain the reaso ns for any program changes or adjustments. Generall y, adjustments in burden result from re - estimating burden and/or from economic phenomenon outside of an agency ’s control (e.g., correcting a burden estimate or an organic increase in the size of the report ing universe). Program changes result from a deliberate action that materiall y changes a collection of information and generall y are result of new statute or an agency8

EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable) action (e.g., changing a form, revising regulations, redefining the respondent universe, etc.). Burden changes should be disaggregated b y ty pe of change (i.e., adjustment, program change due to new statute, and/or program change due to agency discretion), ty pe of collection (new, revision, extension, reinstatement with change, reinstatement w ithout change) and include totals for changes in burden hours , responses and cost s (if applicable) . The burden and responses for this I CR has been disaggregated. There are 7.33 burden hours and 22 responses for state, local and tribal governments and 1 burden hour and 3 responses for the private sector. There are no program changes or adjustments in burden. This is a one time collection and there is no need to collect signed Assurances of Compliance

– Civil Rights Certificate forms from entities that have already submitted a signed form. Our calculation of the burden on the federal government has changed slightly , from $60.96 in 2012 to $69.01 today , largel y due to a cost - of - living increase in the salary of the employee who processes forms received b y OCR. In recent years, OCR has received fewer forms than in the past, but the method for processing the forms has changed and takes slightly more time. These factors offset one another. 16. For collections of information whose results will be published, outline plans for tabulation and publication. Address an y complex anal yt ical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publ ication dates, and other actions. Signed Assurance of Compliance - Civil Rights Certificate forms will not be published. 17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that displ ay would be inappropriate. The Department seeks approval for not displaying an expiration date on the Assurance of Compliance - Civil Rights Certificate form. The assurances provided on the Assurance of Compliance - Civil Rights Certificate form appl y to any Federal financial assistance from, or funds made available through, the Department for which a respondent may apply . A respondent onl y has to submit a signed Assurance of Compliance - Civil Rights Certificate form to OCR once, no matter what funds or financial assistance it seeks from the Department. The display of an expiration date on the Assurance of Compliance - Civil Rights Certificate form will cause confusion concerning the length of time for which the assurance is valid, in that it will imply that respondents have to submit new assurances after the expiration date.9

EDI CS Tr acking and OMB Number: 1870 - 0503 Revised: 0 4 /24 /2015 RI N Number: XXXX - XXXX (if applicable) 18. Explain each exception to the certification statement identified in the Certification of Paperwork Reduction Act. There are no exceptions to the certification statement.