Dss Form 1503 - Assurance Of Compliance With The Department Of Health And Human Services Regulation Under Title Vi, Section 601 Of The Civil Rights Act Of 1964, As Amended

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South Carolina Department of Social Services
ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES REGULATION UNDER TITLE VI,
SECTION 601 OF THE CIVIL RIGHTS ACT OF 1964, AS AMENDED
(Hereinafter Called the Organization)
Name of Organization
HEREBY AGREES THAT it will comply with Title VI, Section 601, of the Civil Rights Act of 1964, as amended, and all
requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part
80) issued pursuant to that title, to the end that in accordance with Title VI, Section 601 of that Act and the Regulation,
no person in the United States shall, on the grounds of race, color, or national origin, otherwise be subjected to
discrimination under any program or activity for which the Organization receives Federal Financial Assistance from the
Department; and HEREBY GIVES ASSURANCE THAT it will immediately take any measures necessary to effectuate
this agreement.
THIS ASSURANCE is given in consideration of and for the purpose of obtaining vendor payments or any other
payments in which Federal Financial Assistance is involved. The organization recognizes and agrees that such Federal
Financial Assistance will be extended in reliance on the representations and agreements made in this assurance, and
that the United States shall have the right to seek judicial enforcement of this assurance. This assurance is binding on
the Organization, its successors, transferees, and assignees, and the person or persons whose signatures appear below
are authorized to sign this assurance on behalf of the Organization.
Name of Organization
Address of Organization (Street Number, P.O. Box, City, State, Zip Code)
Signature of Authorized Official
Date
DSS Form 1503 (MAR 11)

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