OMB Control # 1505-0227 1

Civil Rights Act of 1964 Title VI Narrative for the State Small Business Credit Initiative 

(SSBCI) Investing in America Small Business Opportunity Program (SBOP) – Department of 

the Treasury 

Any state, the District of Columbia, or territory that is recommended for funding under the 

SSBCI Investing in America SBOP will be required to undergo a Title VI of the Civil Rights Act 

pre-award compliance review before being funded and be required to complete a Title VI 

Narrative form. To expedite this review, applicants may, but are not required to submit a Title VI 

Narrative form with the applicant’s SSBCI Investing in America SBOP application. 

The Title VI Narrative form should include the information listed below. If any item listed in the 

Title VI Narrative form is not relevant to the project for which federal financial assistance is 

requested, the item should be marked as “not applicable.” Applicants may refer to Treasury’s 

guidance on limited English proficient (LEP) persons when preparing their application for 

providing language assistance to persons with limited English proficiency.

In lieu of a Title VI Narrative form, applicants may submit a Title VI compliance form recently 

prepared and submitted (within one calendar year) to another federal agency to expedite this 

pre-award compliance review. If any information required by Treasury in the Title VI Narrative 

form is not included in the other agency’s Title VI compliance form, the missing information 

should be submitted with the application on the Title VI Narrative form to expedite the 

pre-award compliance review. 

1. A statement that the Title VI notice to the public is posted in a prominent place or places, 

and the type of postings being used (i.e., in the applicant’s place(s) of business, in written 

communications to the beneficiaries, or on the applicant’s website). 

2. A list of any pending Title VI investigations, complaints, or lawsuits filed with the 

applicant. This list should include those investigations, complaints, or lawsuits that 

pertain to allegations of discrimination on the basis of race, color, and/or national origin 

that pertain to the applicant submitting the narrative. 

3. Information regarding the applicant’s Title VI compliance history if it has previously 

received funding from another federal agency. The information shall include a copy of 

any Title VI compliance review reports issued by such other federal agency in the 

previous two years. The information shall include: 

a. The purpose or reason for the review. 

b. The name of the agency or organization that performed the review. 

c. A summary of the findings and recommendations of the review. 

d. A report on the status and/or disposition of such findings and recommendations. 

4. Applicants that have program-related, non-elected planning boards, advisory councils or 

committees, or similar bodies, the membership of which is selected by the applicant, must 

provide a table depicting the racial breakdown of the membership of those committees, 
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and a description of efforts made to encourage the participation of minorities on such 

committees or councils. 

5. A description of the location of existing or proposed facilities connected with the 

proposed project, program, or activity, and whether the location has or will have the 

effect of unnecessarily denying access to any persons on the basis of prohibited 

discrimination (race, color or national origin). 

6. A list of all Federal agencies providing federal financial assistance. 

7. A description of the procedures the applicant will use to ensure subrecipients comply 

with Title VI and a proposed schedule of Title VI Narrative submissions from the 

subrecipient for this project or program.

8. A copy of the applicant’s plan for providing language assistance to persons with limited 

English proficiency, based on the Treasury LEP Guidance.

PAPERWORK REDUCTION ACT NOTICE

The information collections discussed in this application will be submitted to the Office of 

Management and Budget (OMB) under OMB control number 1505-0227 in accordance 

with the Paperwork Reduction Act of 1995 (44 U.S.C. chapter 35). OMB approval for this 

information collection is forthcoming and the information will be collected following OMB 

approval. This document will be updated to reflect that approval.

The information collected in this application will be used by the U.S. Department of the Treasury to 

determine whether to approve an applicant for grant funding under the SSBCI Investing in America 

SBOP. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of 

information unless it displays a valid control number assigned by the Office of Management and Budget 

(OMB). The estimated burden associated with this collection of information is 6 hours per response. 

Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden 

should be directed to the Office of Privacy, Transparency, and Records, U.S. Department of the Treasury, 

1500 Pennsylvania Ave., N.W., Washington, D.C. 20220. DO NOT send this application form to this 

address.

PRIVACY ACT STATEMENT

The Privacy Act of 1974 (Privacy Act) protects certain information that the federal government has about 

“individuals” (United States citizens and lawfully admitted permanent residents). The Privacy Act does not 

generally apply to businesses, but some federal courts have found that this law applies to sole proprietors (they are 

deemed “individuals” under the Privacy Act).

AUTHORITY: Small Business Jobs Act of 2010 (SBJA), Title III, 12 U.S.C. § 5701 et seq., as amended by the 

American Rescue Plan Act of 2021 (ARPA), section 3301.

PURPOSE: This information is being collected and maintained by Treasury so that it can review and make funding 

decisions regarding applications submitted for grant funding under the SSBCI Investing in America SBOP 

established under the SBJA, as amended by ARPA, and communicate with applicant contacts, and otherwise carry 

out the program.
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ROUTINE USE: The information you furnish may be shared in accordance with the routine uses outlined in 

Treasury .013, Department of the Treasury Civil Rights Complaints, Compliance Reviews, and Fairness in Federal 

Programs Files System of Records Notice (SORN); Treasury .015, General Information Technology Access 

Account Records, 85 Fed. Reg. 73353; and Treasury .017, Correspondence and Contact Information, 81 Fed. Reg. 

78266. For example, one routine use under Treasury .017 allows the disclosure of information to international, 

federal, state, local, tribal, or private entities for the purpose of the regular exchange of business contact information 

in order to facilitate collaboration for official business. More information about this and other routine uses can be 

found in the System of Records Notices (SORNs) listed above, which are posted on Treasury’s website.

DISCLOSURE: Providing this information is voluntary. However, failure to furnish the requested information may 

result in the denial of your application.