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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN Number: XXXX-XXXX (if applicable)

SUPPORTING STATEMENT

FOR PAPERWORK REDUCTION ACT SUBMISSION

ASSURANCE OF COMPLIANCE – CIVIL RIGHTS CERTIFICATE

EDICS Tracking and OMB Number: (4801) 1870-0503

Revised 01/26/2015

A. Justification 

1. Explain the circumstances that make the collection of information necessary. Identify

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 

type of the collection (new, revision, extension, reinstatement with change, reinstatement 

without change). If revised, briefly specify the changes. If a rulemaking is involved, 

make note of the sections or changed sections, if applicable.

This information collection is required by 

 Title VI of 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/fdsys/pkg/CFR-2011-title34-vol1/pdf/CFR-2011-title34-vol1-

sec100-4.pdf); 

 Title 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/fdsys/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/fdsys/pkg/CFR-2011-title34-vol1/pdf/CFR-2011-title34-vol1-

part104.pdf);

 The 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/fdsys/pkg/CFR-2010-title34-

vol1/pdf/CFR-2010-title34-vol1-sec110-23.pdf); and 

 The Boy Scouts of America Equal Access Act of 2001 (Boy Scouts Act), 20 U.S.C. 

7905, 34 C.F.R. 108.8 (requires equal access for the Boy 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), 
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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN Number: XXXX-XXXX (if applicable)

http://www.gpo.gov/fdsys/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 comply with these laws. 

2. Indicate how, by whom, and for 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 by OCR. Respondents only need to sign the Assurance of Compliance – 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 forms 

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 unable to accept electronic signatures. Accordingly, OCR would collect 

the signed Assurance of Compliance forms by traditional (paper) mail. The Assurance of 

Compliance – Civil Rights Certificate form is available electronically on OCR’s website, and 

recipients may print it out to reduce the burden of obtaining the form. 

4. Describe efforts to identify duplication. Show specifically why any 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 is 
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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN Number: XXXX-XXXX (if applicable)

independently 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 significant 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 frequently, as well as any technical or legal 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 

Boy 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 quarterly;

 requiring respondents to prepare a written response to a collection of information in 

fewer than 30 days after receipt 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 connection 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 by 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 

other agencies for compatible confidential use; or
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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN 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 apply 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 by 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. Specifically 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 any), 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 [date] [citation]. No public 

comments were received. A 30 day Federal Register notice was published in the Federal 

Register on [date] [citation]. No public comments were received.

9. Explain any decision to provide any payment or gift to respondents, other than 

remuneration of contractors or grantees with meaningful justification.

No payments or gifts are made or provided to any respondent.

10. Describe any 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 Systems of Record Notice and the date a Privacy Impact 

Assessment was completed as indicated on the IC Data Form. 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 – Privacy Act Implementation –

Guidelines and Responsibilities, OMB Circular A-130 Appendix I – Federal Agency
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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN 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 of 2002, 

OMB M-06-15 – Safeguarding Personally Identifiable Information, OM:6-104 – Privacy

Act of 1974 (Collection, Use and Protection of Personally Identifiable Information). If 

the collection is subject to the Privacy Act, the Privacy Act statement is deemed 

sufficient with respect to confidentiality. If there is no expectation of confidentiality, 

simply state that the Department makes no pledge about the confidentially of the data.

There are no assurances of confidentiality provided.

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 considers 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 on 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 type (federal government, 

individuals or households, 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 identification of burden type: 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 ROCIS IC Burden 

Analysis 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 collection 
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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN 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 respondents 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.

Occasionally, 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 years, 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 year period for which the Assurance of Compliance – 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 year 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 factors 

including system 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.
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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN Number: XXXX-XXXX (if applicable)

 If cost estimates are expected to vary widely, agencies should present ranges of cost 

burdens 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 analysis 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 quantification of 

hours, operational expenses (such as equipment, overhead, printing, and support staff), 

and any other expense that would not have been incurred without this collection of 

information. Agencies also may aggregate cost estimates from Items 12, 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 year. 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 reasons for any program changes or adjustments. Generally, 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 reporting universe). Program changes result from a deliberate action that materially 

changes a collection of information and generally are result of new statute or an agency
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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN Number: XXXX-XXXX (if applicable)

action (e.g., changing a form, revising regulations, redefining the respondent universe, 

etc.). Burden changes should be disaggregated by type of change (i.e., adjustment, 

program change due to new statute, and/or program change due to agency discretion), 

type of collection (new, revision, extension, reinstatement with change, reinstatement

without change) and include totals for changes in burden hours, responses and costs (if 

applicable).

The burden and responses for this ICR 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 onetime 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, largely due to a cost-of-living increase in the salary of the employee 

who processes forms received by 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 any complex analytical 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, publication 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 display 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 apply to any Federal financial assistance from, or 

funds made available through, the Department for which a respondent may apply. A 

respondent only 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.
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EDICS Tracking and OMB Number: (4801) 1870-0503

Revised: 01/26/2015

RIN 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.