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S.W. Washington D.C. 20201 Name of Healthcare Facility Receiving/Requesting Funding Street Address City State Zip Code Form HHS-690 3/2011. ASSURANCE OF COMPLIANCE REHABILITATION ACT OF 1973 TITLE IX OF THE EDUCATION AMENDMENTS OF 1972 AND THE AGE DISCRIMINATION ACT OF 1975 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 Pub. L* 88-352 as amended 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 subje....

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How to fill out the HHS-690 online

The HHS-690 form, known as the Assurance of Compliance, is essential for individuals or organizations seeking federal financial assistance from the U.S. Department of Health and Human Services. This guide provides a clear and detailed approach to filling out the form online.

Follow the steps to complete the HHS-690 form online.

  1. Press the ‘Get Form’ button to access the HHS-690 and open it for completion.
  2. Begin with the 'Applicant Information' section. Enter the name of the agency requesting funding, ensuring accurate spelling and formatting.
  3. Fill in the 'Address Information' fields, including street address, city, state, and zip code. This information should reflect the official address of the applicant.
  4. In the 'Assurance of Compliance' section, carefully review and acknowledge the various civil rights laws and regulations listed. Ensure you understand each section's implications.
  5. Continue to the 'Certification' area, where the authorized official will sign the document. It is critical that this signature is from a person who has the authority to commit the applicant to the terms outlined in the form.
  6. Enter the date of signing in the 'Date' field next to the signature section.
  7. After you've completed the form, you can save your changes, download a copy for your records, print it, or share the form as necessary.

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