5310 Title VI Checklist  

This checklist is intended for use by transit personnel who are in charge of managing their agency’s Title 

VI compliance actions. The goal of this checklist is to report and track that your agency has provided the 

necessary information and completed the necessary actions to fulfill its Title VI obligations under FTA 

Circular 4702.1B.  Section 601 under Title VI of the Civil Rights Act of 1964 states the following: 

“No person in the United States shall, on the grounds of race, color, or national origin, be excluded from 

participation in, be denied the benefits of, or be subjected to discrimination under any program or 

activity receiving Federal financial assistance.” 

Please complete this document in entirety and submit with your agency’s annual application to the 

Nebraska Department of Roads. 

Agency Contact Information 

Agency Name:  ________________________________________________________________________  Title VI Transit Manager:  ________________________________________________________________  Address:  _____________________________________________________________________________  Phone:  _____________________  Email Address:  _______________________________________  Transit Website:  _________________________________________________________________  Please check and/or complete the following, regarding your agency’s federal transit funding status:  

___ 5310 Subrecipient     OR     ___ 5311 Subrecipient  ___ First‐time Applicant                     ___ On‐going Recipient    Title VI Plan Submission to NDOR (submission year): ______________  Please attach a copy of the signed board or governing body resolution approving the agency’s Title VI plan.  

 

 

 

 

 

Part A: Title VI Notices and Forms Step 1: The Title VI Notice to the Public is posted in the following locations:

On the agency website (NOTE: if you do not have a website, this does not apply) In each service vehicle In a public location at each branch office

Step 2: The Discrimination Complaint Form is:

Downloadable/printable in English and Spanish on the agency website (NOTE: if you do not have a website, this does not apply).

Stored in English, Spanish, and other languages in each service vehicle for upon-request distribution.

Stored in English, Spanish, and other languages at each branch office for upon-request distribution.

Step 3: The Complaint Procedures Form is:

Downloadable/printable in English and Spanish on the agency website. (NOTE: if you do not have a website, this does not apply).

Stored in English, Spanish, and other languages in each service vehicle for upon-request distribution.

Stored in English, Spanish, and other languages at each branch office for upon-request distribution.

 

 

 

 

 

 

 

 

 

 

 

Part B: Public Participation Plan Prior to submitting a funding request to NDOR, the agency will engage in the following activities to solicit public participation:

Notify by certified mail each public and private transit and paratransit operator in its service area. The notification will describe the type of funding that is being requested for the proposed service area in which the organization plans to provide transportation service. The notification will request comments from each operator concerning their ability and desire to provide transportation service in the same area.

Issue a public notice in a newspaper generally available to the public and private agencies and

operators in the service area. The notice will describe what funding is being requested and the transportation services to be offered. The notice will invite any interested public or private transit or paratransit operator within the service area to comment on the funding application by sending a written notice to the Nebraska Department of Roads Rail and Public Transportation Division and/or the applicant agency within 30 days of the public notice.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part C: Language Assistance Plan The Title VI Notice to the Public, Discrimination Complaint Form, and Complaint Procedures Form

should be readily available in English, Spanish, and other languages for upon-request distribution. Reasonable steps should be taken to provide translations of other documents in the event they are

requested by LEP persons. Contact NDOR for these requests.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part D: Employee Training All transit personnel have read the agency’s Title VI Plan and signed the Employee Training Form All personnel are familiar with agency’s Title VI complaint procedures. An agency staff member has attended Title VI training through NDOR.