Where can a facility obtain a Statement of Assurance of Compliance with Title VI of the Civil Rights Act of 1964, the Civil Rights Agreement form?
Each facility must have on file with the DAAS, a Civil Rights Agreement (form DSS-1464-ia). This is a federal law as well as a NC statutory requirement to participate in the SA program. Facilities must assure that they will not discriminate against their residents on the basis of race, color, or national origin. A new form must be completed when there is a change in the license or ownership of the facility. The form must be completed, signed, and either mailed, faxed, or scanned and emailed to Monica Nealous at the DAAS.
