Title VI Compliance Survey

INTRODUCTION

The Tennessee Department of Human Services (DHS) requires its sub-recipients to comply with Title VI of the Civil Rights Act of 1964. Title VI is the federal law that prohibits recipients of federal funding from discriminating on the basis of race, color, or national origin. In order to verify compliance with Title VI, each recipient of DHS funding must submit responses to the Title VI Compliance Plan Survey. This survey must be completed each year by each facility or agency sub-recipient contracting with DHS. If your agency is responsible for multiple contracts, you must complete the survey for each facility contracted.

Thank you for your assistance.

NOTE: Please use a computer to complete the survey. Upon completing the survey you will be re-directed to the first page of the survey. If you are only entering data for one site, returning to this page means your entry is complete and has been received. If you are entering data for multiple sites, please continue with this process until all entries are complete.

If you have any questions or require assistance, please call (615) 313-4748 or email ComplianceOfficer.DHS@tn.gov

***DHS uses an encrypted version of Survey Monkey for data security.***

Question Title

* 1. Please complete the following:

Facility/Agency Name:

Owner's Name:

Address:

City:

County:

State/Province:

ZIP/Postal Code:

Email Address:

Business Phone Number:

Name of Person Responsible for Title VI Compliance:

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