OMB Control No. 1820-0658

Exp. Date: 

REHABILITATION SERVICES ADMINISTRATION

ASSURANCES FOR THE PROTECTION AND ADVOCACY FOR ASSISTIVE 

TECHNOLOGY (PAAT) PROGRAM

Yes An eligible system

(1) has in effect a system to provide protection and advocacy services for the purposes of 

assisting in the acquisition, utilization, or maintenance of assistive technology

or assistive technology services for individuals with disabilities;

(2) shall annually prepare and submit to the secretary a report that contains such information 

as the secretary may require, including documentation of the progress of the entity in--

 (A) conducting consumer-responsive activities, including activities that will lead to 

increased access, for individuals with disabilities, to funding for assistive technology 

devices and assistive technology services;

(B) engaging in informal advocacy to assist in securing assistive technology and 

assistive technology services for individuals with disabilities;

 (C) engaging in formal representation for individuals with disabilities to secure 

systems change, and in advocacy activities to secure assistive technology and 

assistive technology services for individuals with disabilities;

(D) developing and implementing strategies to enhance the long-term abilities of 

individuals with disabilities and their family members, guardians, advocates, and 

authorized representatives to advocate the provision of assistive technology devices 

and assistive technology services to which the individuals with disabilities are 

entitled under law other than the Assistive Technology Act of 1998 (AT Act); and

 (E) coordinating activities with protection and advocacy services funded through 

sources other than this title, and coordinating activities with the capacity building and 

advocacy activities carried out by the State agency funded pursuant to section 101 of 

the AT Act;

(3) shall prepare and submit to the state agency funded pursuant to section 101 of the AT Act,

the report described in (2) above, and quarterly updates regarding those activities;

(4) shall comply with all relevant provisions of the Education Department General 

Administrative Regulations (EDGAR).

As a duly authorized representative of the applicant, I hereby certify that the applicant will comply with the above assurances.

Name of Applicant:

Printed name and title of authorized representative:

Signature: Date:

Public Burden Statement:

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of 

information unless such collection displays a valid OMB control number. Public reporting burden for this collection 

of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching 

existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of 

information. The obligation to respond to this collection is required to obtain or retain benefit (Public Law 108-364-

102). Send comments regarding the burden estimate or any other aspect of this collection of information, including 

suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, 

DC 20210-4537 or email ICDocketMgr@ed.gov and reference the OMB Control Number 1820-0658. Note: Please 

do not return the completed assurances to this address.

If you have comments or concerns regarding the status of your individual submission of this form, 

write directly to: U.S. Department of Education Rehabilitation Services Administration 400 Maryland 

Avenue, S.W. PCP Room 5030 Washington, DC 20202-2800.