HHS-690 2019-2025 free printable template

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...

How to fill out form hhs 690

How to fill out HHS-690

1. Obtain the HHS-690 form from the official website or local health department.
2. Review the instructions included with the form to understand the required information.
3. Fill out personal identification information including name, address, and contact details.
4. Provide demographic information such as date of birth and gender.
5. Indicate household income and size accurately.
6. Include information about health insurance status and any medical needs.
7. Review the form for accuracy and completeness.
8. Sign and date the form where required.
9. Submit the completed form to the designated agency.

Who needs HHS-690?

1. Individuals applying for healthcare assistance or benefits.
2. Families seeking public health services or support.
3. Low-income individuals needing access to medical care or programs.

• Who needs a form HHS-690?
• What is form HHS-690 for?
• Is it accompanied by other forms?
• • When is form HHS-690 due?
  • How do I fill out a form HHS-690?
  • Where do I send it?

Who needs a form HHS-690?

Organizations that apply for a federal grant, need form HHS-690 to be on file with the Department of Health and Human Services. It is enlisted as the first document to submit with an original application on the HHS checklist (form 5161-1).

What is form HHS-690 for?

Form HHS-690 stands for Assurance of Compliance. There used to be 4 separate forms to assure applicant’s compliance with Civil Rights Act (1964), Rehabilitation Act (1973), Education Amendments (1972), and the Age Discrimination Act (1975). Now they are all united under form HHS-690.

Is it accompanied by other forms?

Applying for a federal grant is a complicated multi-stage process. It involves a number of federal institutions. To make sure you’ve gathered all the requested forms, you can check out the list on the HHS form 5161-1.

When is form HHS-690 due?

The due date is the same as the due date for a federal grant application.

How do I fill out a form HHS-690?

There is only one sheet to fill out. You must read every paragraph carefully. It is a legally binding assurance that all the documents and your further activity during the project are and will be in compliance with the legal acts, listed on this form. When you are ready to put signature and date, you must also type your name and position you hold in the applying organization. Also, you should type name of healthcare facility receiving/requesting funding and its address.

Where do I send it?

The mailing address is:

U.S. Department of Health and Human Services

Office for Civil Rights

200 Independence Ave., S.W.

Washington, D.C. 20201

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What is HHS-690?

HHS-690 is a report form used by the U.S. Department of Health and Human Services to collect information regarding the performance of certain health programs and services.

Who is required to file HHS-690?

Entities that receive funding from the U.S. Department of Health and Human Services, such as healthcare providers and organizations, are required to file HHS-690.

How to fill out HHS-690?

To fill out HHS-690, organizations must provide necessary data related to program performance metrics, participant demographics, and financial expenditures as specified in the form's instructions.

What is the purpose of HHS-690?

The purpose of HHS-690 is to assess the effectiveness of health programs funded by HHS and to ensure compliance with reporting requirements.

What information must be reported on HHS-690?

Information that must be reported on HHS-690 includes program participant data, performance measures, financial data, and any other information deemed necessary by the funding agency.