Article Structure
The HHS 690 form serves as an essential tool for organizations seeking federal funding from the U.S. Department of Health and Human Services. This form confirms an organization’s commitment to comply with various civil rights laws, ensuring that no individual faces discrimination based on race, color, national origin, sex, age, or disability when participating in programs that receive federal assistance. It addresses compliance with landmark legislation, including Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973. By signing this form, an applicant agrees to uphold the principles outlined in these laws, as well as other relevant regulations aimed at protecting the rights of individuals. The form emphasizes that this assurance is not just a one-time commitment; rather, it remains binding throughout the duration of federal assistance. Additionally, applicants can opt to complete this form through an online portal, simplifying the process of compliance while reinforcing the importance of adhering to these civil rights protections. The HHS 690 also underscores that failure to comply may impact continued access to federal funds. Thus, understanding and properly completing the HHS 690 form is crucial for any entity involved in federal financial assistance programs.
Hhs 690 Example
OMB Control Number
Exp. Date: 12/31/2022
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
ASSURANCE OF COMPLIANCE
Under the Paperwork Reduction Act of 1995, as amended, and 5 C.F.R. § 1320.5(b)(2)(i), persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. The OMB control number for this collection is
ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, SECTION 504 OF THE REHABILITATION ACT OF 1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972, THE AGE DISCRIMINATION ACT OF 1975, SECTION 1557 OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT, AND FEDERAL CONSCIENCE AND
*With respect to compliance with 45 C.F.R. Part 88, the signatory is providing assurance of compliance with such Part to the extent it is in effect during the term of the award. Consistent with applicable court orders, the version of Part 88 in effect as of December 2, 2019, is found at 76 Fed. Reg.
The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants, loans, contracts, property, discounts or other Federal financial assistance from the U.S. Department of Health and Human Services.
THE APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH:
1.Title VI of the Civil Rights Act of 1964, as amended (codified at 42 U.S.C. § 2000d et seq.), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
2.Section 504 of the Rehabilitation Act of 1973, as amended (codified at 29 U.S.C. § 794), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified individual with a disability in the United States shall, solely by reason of her or his disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
3.Title IX of the Education Amendments of 1972, as amended (codified at 20 U.S.C. § 1681 et seq.), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Department.
4.The Age Discrimination Act of 1975, as amended (codified at 42 U.S.C. § 6101 et seq.), and all requirements
imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department.
5.Section 1557 of the Patient Protection and Affordable Care Act, as amended (codified at 42 U.S.C. § 18116), and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 92), to the end that, in accordance with Section 1557 and the Regulation, no person in the United States shall, on the ground of race, color, national origin, sex, age, or disability be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health program or activity for which the Applicant receives Federal financial assistance from the Department.
6.As applicable, the Church Amendments, as amended (codified at 42 U.S.C. §
The Applicant agrees that compliance with this assurance constitutes a condition of continued receipt of Federal financial assistance, and that it is binding upon the Applicant, its successors, transferees and assignees for the period during which such assistance is provided. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. The Applicant further recognizes and agrees that the United States shall have the right to seek judicial enforcement of this assurance.
The person whose signature appears below is authorized to sign this assurance and commit the Applicant to the above provisions.
Date
Please mail form to:
U.S. Department of Health & Human Services Office for Civil Rights
200 Independence Ave., S.W. Room 509F Washington, D.C. 20201
Signature of Authorized Official
Name and Title of Authorized Official (please print or type)
Name of Agency Receiving/Requesting Funding
Street Address
City, State, Zip Code
The Applicant may provide this assurance via the U.S. Department of Health and Human Services’ Assurance of Compliance online portal at https://ocrportal.hhs.gov/ocr/aoc/instruction.jsf in lieu of mailing it to the address provided.
HHS Form 690 (Last updated 11/2019)
Form Characteristics
| Fact Name | Fact Description |
|---|---|
| OMB Control Number | The OMB Control Number for the HHS 690 form is 0945-0008. |
| Expiration Date | This form's expiration date was December 31, 2022. |
| Governing Laws | Compliance is required under various federal laws, including Title VI of the Civil Rights Act of 1964 and the Rehabilitation Act of 1973. |
| Online Submission | Applicants may submit the assurance online via the HHS Assurance of Compliance portal instead of mailing a hard copy. |
| Pertinent Regulations | The regulations relevant to this form include 45 C.F.R. Parts 80, 84, 86, 91, and 92. |
| Funding Purpose | The assurance must be provided to obtain federal grants, loans, contracts, or other financial assistance from HHS. |
| Binding Agreement | By signing, the applicant agrees to comply with the assurance, which is binding upon them and their successors. |
| Document Authority | The person signing the form must be authorized to commit the applicant to the provisions contained within. |
Guidelines on Utilizing Hhs 690
Filling out the HHS 690 form is essential for organizations seeking federal financial assistance from the U.S. Department of Health and Human Services. This document ensures compliance with various civil rights laws and provides assurances that the applicant will adhere to non-discrimination policies. It is important to fill it out carefully, as it represents a commitment to uphold the rights of individuals protected by these laws.
- Start by downloading the HHS 690 form from the official website or accessing it through the designated online portal.
- Begin with the section labeled “OMB Control Number” and verify that the control number “0945-0008” is present.
- Write the expiration date “12/31/2022” in the appropriate field.
- Fill in the name of the agency requesting funding in the section titled “Name of Agency Receiving/Requesting Funding.”
- Complete the address section: include the street address, city, state, and zip code of the agency.
- Provide the name and title of the authorized official who will sign the form. Ensure the name is printed or typed clearly.
- In the signature section, the authorized official must sign and date the form. This confirms their commitment to the regulations outlined in the document.
- Before mailing, double-check all entries for accuracy and completeness.
- Mail the completed form to:
- U.S. Department of Health & Human Services
- Office for Civil Rights
- 200 Independence Ave., S.W. Room 509F
- Washington, D.C. 20201
- If preferred, the form can also be submitted via the online Assurance of Compliance portal, eliminating the need for mailing.
What You Should Know About This Form
What is the HHS 690 form used for?
The HHS 690 form, also known as the Assurance of Compliance, is used by applicants seeking federal financial assistance from the U.S. Department of Health and Human Services. By submitting this form, applicants assure compliance with various civil rights and anti-discrimination laws, which include Title VI of the Civil Rights Act and the Rehabilitation Act, among others. Completing this form is a prerequisite for receiving grants, loans, contracts, or other assistance from the federal government.
How can I submit the HHS 690 form?
The HHS 690 form can be submitted in two ways. Applicants have the option to complete a hard copy of the form and mail it to the Office for Civil Rights at the address provided. Alternatively, applicants may use the online portal created by the Department of Health and Human Services to provide the assurance of compliance. The online submission can be completed at this link.
Who needs to sign the HHS 690 form?
The form must be signed by an authorized official of the applicant organization. This person is responsible for committing the organization to comply with all provisions outlined in the HHS 690 form. Make sure to read through the assurance clauses thoroughly to understand the commitments being made on behalf of your organization.
What happens if I do not submit the HHS 690 form?
If the HHS 690 form is not submitted, the applicant will not be eligible to receive federal financial assistance from the Department of Health and Human Services. Compliance with the assurances outlined in the form is a condition for obtaining funding. Failing to submit the form could result in delays or denial of funding requests.
Where do I mail the hard copy of the HHS 690 form?
If you choose to submit a hard copy of the HHS 690 form, it should be mailed to the following address:
U.S. Department of Health & Human Services
Office for Civil Rights
200 Independence Ave., S.W.
Room 509F
Washington, D.C. 20201
Common mistakes
Filling out the HHS Form 690 accurately is essential for ensuring compliance with federal regulations. Many people make mistakes that can delay the processing of their applications. One common error is leaving sections incomplete. Applicants often skip questions or do not provide enough detail in the sections asking for specific information about their organization or funding needs. This can lead to the form being returned for corrections, which can significantly slow down the application process.
Another mistake involves mismatched signatures. The person signing the form must be authorized to do so on behalf of the organization. If an unauthorized individual signs the form, it may be considered invalid, requiring resubmission. It’s important that the authorized official not only signs the document but also includes their name and title clearly, ensuring that all information is easy to read and verify.
Some applicants fail to check the expiration date of the form before submission. The current version of the HHS Form 690 must be in use; otherwise, it may be deemed outdated. Using an expired form can lead to unnecessary complications. Always ensure that the current version of the form is in hand before filling it out.
One often-overlooked aspect is keeping a copy of the submitted form. Many applicants do not make a copy of the completed form before sending it to the Department of Health and Human Services. Without a copy, tracking the submission or clarifying details later becomes challenging. Keeping a record ensures all parties can refer back to the terms outlined in the application.
Furthermore, mistakes in contact information occur frequently. Miswriting an email address or phone number can result in missed communications from the HHS regarding the status of the application. Applicants should double-check all provided contact information to prevent potential issues.
Lastly, some applicants neglect to review the regulations that the form pertains to before completing it. Accessing resources from the U.S. Department of Health and Human Services can inform applicants about the relevant laws and regulations they must comply with. Understanding these requirements helps in accurately completing the form and avoiding compliance issues.
Documents used along the form
The Hhs 690 form is a critical document that assures compliance with important federal civil rights laws when applying for federal financial assistance. To properly navigate the application process, several other forms and documents often accompany the Hhs 690, enhancing clarity and comprehensiveness in demonstrating compliance. Below is a list of these documents, each accompanied by a brief description.
- Hhs 691 Form: This form is used to report additional demographic information about organizations seeking federal funds. It helps the Department of Health and Human Services compile data on diversity and inclusion within funded programs.
- Compliance Assurance Letter: A letter that further outlines how the applicant plans to meet the requirements of federal civil rights laws. It may provide details about policies and practices already in place to ensure compliance.
- Program Narrative: This document describes the proposed program's objectives, methods, and expected outcomes. It supplements the Hhs 690 by offering a fuller picture of how the program will comply with civil rights protections.
- Budget Justification: Accompanies grant applications and outlines the proposed budget for the project. This includes items such as personnel costs, equipment, and operational expenses, clarifying the allocation of federal funds.
- Data Collection Plan: A detailed plan outlining how the applicant will collect and report data related to program participants. This document is vital for tracking compliance with various non-discrimination laws.
- Affirmative Action Plan: Required for applicants seeking certain types of federal funding, this plan details the strategies an organization will implement to ensure equal opportunity and address underrepresentation in their programs.
- Public Notice and Communication Plan: This document outlines how the applicant will inform the public about the availability of programs and services, ensuring that those entitled to benefits are aware of their rights and the non-discrimination policy.
Each of these documents plays a vital role in ensuring that applicants not only comply with federal regulations but also promote fairness and equity within their programs. Properly preparing these forms enhances the likelihood of approval and establishes a foundation for accountability and transparency in federally-funded initiatives.
Similar forms
The HHS 690 form is an important document used for ensuring compliance with various federal civil rights and non-discrimination laws. It shares similarities with several other forms and documents that also aim to promote adherence to legal and ethical standards in various sectors. Here are six documents that are comparable to the HHS 690 form:
- Title VI Compliance Form: Like the HHS 690, this form ensures that no person is denied participation in a federally funded program based on race, color, or national origin. Both emphasize the importance of non-discrimination in program activities.
- Rehabilitation Act Section 504 Assurance: This document provides assurance that individuals with disabilities will not face discrimination in federally funded programs. The HHS 690 similarly addresses disability discrimination, ensuring compliance with federal standards.
- Title IX Assurance Form: This document ensures equal treatment in educational programs, focusing specifically on eliminating discrimination based on sex. Like the HHS 690, it aims to protect the rights of all individuals in programs receiving federal funds.
- Age Discrimination Act Compliance Form: This form safeguards against age-related discrimination in federal assistance programs. The HHS 690 also addresses age discrimination, aiming to protect individuals across all age groups in federally funded activities.
- Section 1557 Assurance of Compliance: As part of the Affordable Care Act, this form ensures non-discrimination in health programs on various grounds including race, sex, and disability. The HHS 690 shares this focus, ensuring compliance in health-related programs as well.
- Federal Conscience Protection Form: This document emphasizes the protection of individual rights related to conscience and belief in federally funded programs. It parallels the HHS 690's commitment to ensuring no discrimination occurs based on personal beliefs while receiving federal assistance.
These forms are crucial for organizations receiving federal assistance, as they not only promote adherence to legal standards but also safeguard the rights of diverse populations across various sectors.
Dos and Don'ts
Filling out the HHS 690 form is a critical step in ensuring compliance with various federal regulations. Here’s a list of seven important dos and don’ts to consider while completing this form.
- Do ensure all required fields are completed accurately. Incomplete forms could delay processing.
- Do read the instructions thoroughly before filling out the form. Understanding the requirements is essential.
- Do provide truthful information. Misrepresentation can result in serious consequences, including the loss of funding.
- Do use the online portal for submission if possible. It can simplify the process and provide immediate confirmation of your submission.
- Don't use outdated versions of the form. Always check that you have the latest version available.
- Don't disregard deadlines. Submissions made after the due date may not be accepted.
- Don't overlook the importance of a clear signature and date from the authorized official. These elements are crucial for validation.
Misconceptions
- Misconception: The HHS 690 Form is only for large organizations. Many believe this form is reserved for only the largest entities receiving federal financial assistance. In reality, any organization, irrespective of size, that qualifies for federal assistance must complete this form to ensure compliance with civil rights and anti-discrimination laws.
- Misconception: Submission of the HHS 690 Form guarantees funding. While completing the HHS 690 Form is necessary, it does not guarantee that an organization will receive funding. The form is a declaration of compliance but other factors, such as project viability and budget, also influence funding decisions.
- Misconception: The HHS 690 Form is optional. Some think that filling out the HHS 690 Form is optional if they believe they already comply with relevant laws. However, submission is a requirement for organizations that seek federal funds, making it essential to complete the form.
- Misconception: The online submission option is not legitimate. There is a belief that submitting the form online is less formal than mailing it in. The online portal is an official and valid method of submission, designed to simplify the process while maintaining compliance.
- Misconception: Only specific types of discrimination are covered by the HHS 690 Form. While some individuals think that the form addresses only racial discrimination, it actually encompasses many types, including gender, age, disability, and more. The comprehensive coverage aims to protect all individuals' rights.
- Misconception: Once the form is submitted, no further actions are necessary. After submission, organizations often assume their responsibilities end there. The truth is they must continuously adhere to the compliance measures stated in the form throughout the entire period of receiving federal funds.
- Misconception: The assurances provided in the HHS 690 Form can be disregarded. Some organizations mistakenly believe that the commitments made in the HHS 690 Form can be overlooked. However, these assurances are legally binding, and non-compliance can lead to severe repercussions, including funding withdrawal.
Key takeaways
Filling out and using the HHS 690 form requires attention to detail and an understanding of compliance regulations. Here are some key takeaways to consider:
- The HHS 690 form is associated with federal compliance regulations, specifically regarding civil rights and non-discrimination.
- It is important to complete this form accurately to ensure eligibility for federal funding from the U.S. Department of Health and Human Services.
- The form can be submitted either by mailing a hard copy or through an online portal, which provides flexibility for applicants.
- Applicants must ensure they agree to comply with several federal laws that prohibit discrimination.
- Signing the form commits the applicant to uphold the standards of various civil rights acts and other regulations.
- Failure to comply with the assurances on the form can result in the loss of federal funding.
- Details about the required assurances can be found in the applicable sections of the referenced laws and regulations.
- The form includes an OMB control number that must be recognized during the application process.
- Submission of the form is a prerequisite for receiving federal grants, contracts, or loans from the department.
Overall, careful consideration of the requirements and obligations outlined in the HHS 690 form is essential for successful compliance and continued federal support.
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