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 0945-0008. In lieu of completing this hard copy form and mailing it in,
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.
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 NONDISCRIMINATION LAWS
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:
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Title VI of the Civil Rights Act of 1964, as amended (codified at 42 U.S.C. § 2000d et seq.),
and all requirementsimposed 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 (including limited English proficiency) be excluded fromparticipation in,
be denied the benefits of,
or be otherwise subjected to discrimination under any program oractivity for which the Applicant receives Federal financial assistance from the Department.
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Section 504 of the Rehabilitation Act of 1973, as amended (codified at 29 U.S.C. § 794),
and all requirementsimposed 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 individualwith a disability in the United States shall,
solely by reason of their disability, be excluded from participation in,be denied the benefits of,
or be subjected to discrimination under any program or activity for which the Applicantreceives Federal financial assistance from the Department.
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Title IX of the Education Amendments of 1972, as amended (codified at 20 U.S.C. § 1681 et seq.),
and allrequirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45C.F.R. Part 86),
to the end that, in accordance with Title IX and the Regulation, no person in the United Statesshall, on the basis of sex (including pregnancy,
sexual orientation, and gender identity), be excluded fromparticipation in, be denied the benefits of,
or be otherwise subjected to discrimination under any educationprogram or activity for which the Applicant receives Federal financial assistance from the Department.
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The Age Discrimination Act of 1975, as amended (codified at 42 U.S.C. § 6101 et seq.),
and all requirementsimposed 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 basisof age, be denied the benefits of,
be excluded from participation in,
or be subjected to discrimination under anyprogram or activity for which the Applicant receives Federal financial assistance from the Department.
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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 UnitedStates shall, on the ground of race, color,
national origin (including limited English proficiency), age, disability,or sex (including pregnancy, sexual orientation,
and gender identity) be excluded from participation in, be deniedthe benefits of,
or be subjected to discrimination under any health program or activity for which the Applicantreceives Federal financial assistance from the Department.
As applicable, the Church Amendments, as amended (codified at 42 U.S.C. § 300a-7),
the Coats-Snowe Amendment (codified at 42 U.S.C. § 238n), the Weldon Amendment (e.g., Consolidated Appropriations Act, 2022,
Pub. L. No. 117-103, Div. H, Title V § 507(d), 136 Stat 49, 496 (Mar. 15, 2022)) as extended by the Continuing Appropriationsand Ukraine Supplemental Appropriations Act,
2023, Pub. L. No. 117-180, Div. A, § 101(8) (Sep. 30, 2022); , Section1553 of the Patient Protection and Affordable Care Act, as amended (codified at 42 U.S.C. § 18113),
and Section1303(b)(4) of the Patient Protection and Affordable Care Act, as amended (codified at 42 U.S.C. § 18023(b)(4)), and45 C.F.R. Part 88,
to the extent that the rights of conscience are protected and associated discrimination andcoercion are prohibited,
in any program or activity for which the Applicant receives Federal financial assistance.Consistent with applicable court orders,
the version of Part 88 in effect as of [October 20, 2022] is found at 76 Fed.Reg. 9968-9977 (Feb. 23, 2011).
The Applicant agrees that compliance with this assurance constitutes a material 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.