2025 Caltrans DLATitle VI of the Civil Rights Act of 1964Program Assessment Online Form

2025 Caltrans DLA

Title VI of the Civil Rights Act of 1964

Program Assessment Online Form

Per 23 CFR 200.9(b)(7), Caltrans is mandated to assess Local Public Agencies (LPAs) to ensure compliance with Title VI of the Civil Rights Act of 1964 (Title VI), which prohibits discrimination on the basis of race, color, or national origin (including Limited English Proficiency). LPAs are required to complete this assessment every two years (odd years) or when requested.

The questions asked in this assessment are associated with Title VI and FHWA’s Title VI program requirements (23 CFR Part 200). Caltrans will use this assessment tool to gauge the agency's compliance with Title VI through a Title VI Desk Program Assessment or a Title VI Onsite Program Assessment. When the agency is selected for the assessment, Caltrans will provide a report that includes a compliant status, findings (if any), and recommendations. The agency will be asked to develop a corrective action plan if findings exist.

Since this assessment does not save progress, the assessment must be completed in one sitting, which may take at least 30 minutes to complete if all information and documents are available.

If you have any questions regarding this assessment, please email Loi Tran at loi.tran@dot.ca.gov. Thank you for completing this assessment.

Title VI Program Assessment Online Form Questions (PDF)

Title VI Program Assessment Online Form – Frequently Asked Questions

City/MPO/LPA*

Select

Division/Department*

Name (Responder)*

Title*

Address*

City*

Zip Code*

Phone Number*

Phone

Email Address*

Does the agency receive FHWA funds through Caltrans Division of Local Assistance?*

Yes

If no, there are no further questions, please click submit button.

Title VI Implementation Plan (Title VI Plan)

(28 CFR 42.415 and 23 CFR 200.9(b)(11))

Does your agency have a Title VI Implementation Plan (Title VI Plan) that satisfies the requirements of the Federal Highway Administration (FHWA)?*

Yes

If yes, upload a copy of the agency’s most recent Title VI Plan in the attachments section at the end of the form.

If no, provide an estimated date when the Title VI Plan will be completed.*

If yes, when was the agency’s current Title VI Implementation Plan published?*

Does the Title VI Plan cover race, color, and national origin (including Limited English Proficiency) under Title VI of the Civil Rights Act of 1964?*

Yes

Does the Title VI Plan include all of the items listed in the DLA FHWA Title VI Program Checklist?*

DLA FHWA Title VI Program checklist

Yes

Is the Title VI Plan posted on the agency’s website?*

Yes

Link to Title VI plan*

If no, does the agency plan to post the Title VI Plan?*

Yes

If yes, provide an estimated date when the plan will be posted.*

If no, how does the agency plan to make it available to the public?*

1. Made available at an agency facility (Library, City Hall, main office, etc.)

2. Available upon request

3. Other - Please specify.

Other - Please specify*

Title VI Coordinator

(23 CFR 200.9(b)(1))

Does the agency have a Title VI Coordinator?*

Yes

If yes, provide the Title VI Coordinator’s contact information below.

Title VI Coordinator Name*

Title VI Coordinator Address*

Title VI Coordinator Phone*

Phone

Title VI Coordinator Email*

If no, provide an estimated date when a Title VI Coordinator will be designated as the person responsible for the agency’s Title VI Program.*

Does the Title VI Coordinator have access to the head of the agency?*

Yes

If no, please explain.*

Is the Title VI Coordinator’s contact information made available to the public?*

Yes

If yes, how is it made available?*

1. Website

2. Postings (Posters, etc.)

3. Handouts (Flyers, brochures, etc.)

4. Other - Please specify.

Other - Please specify*

If no, provide an estimated date when the Title VI Coordinator’s contact information will be made available to the public.*

Title VI/Non-Discrimination Policy Statement

(49 CFR 21.7(b))

Does the agency have a Title VI/Non-Discrimination Policy Statement?*

Yes

If yes, upload a copy of the agency’s most recent Title VI Non-Discrimination Policy Statement in the attachments section at the end of the form.

If no, provide an estimated date when the Title VI/Non-Discrimination Policy Statement will be completed.*

Does the Title VI/Non-Discrimination Policy Statement cover race, color, and national origin (including Limited English Proficiency) under Title VI of the Civil Rights of 1964?*

Yes

Is the Title VI/Non-Discrimination Policy Statement signed by the head of the agency?*

Yes

If no, provide an estimated date when the Title VI/Non-Discrimination Policy Statement will be signed by the head of the agency.

Is the Title VI/Non-Discrimination Policy Statement made available to the public?*

Yes

If yes, how is it made available?*

1. Website

2. Postings (Posters, etc.)

3. Handouts (Flyers, brochures, etc.)

4. Other - Please specify.

Title VI/Non-Discrimination Policy Link*

Other - Please specify*

If no, how does the agency plan to make it available to the public?*

1. Website

2. Postings (Posters, etc.)

3. Handouts (Flyers, brochures, etc.)

4. Other - Please specify.

Other - Please specify*

Limited English Proficiency (LEP) Assessment (Four Factor Analysis)/ Language Access Plan (LAP)

(Executive Order 13166)

Has the agency performed a Limited English Proficiency (LEP) Assessment (Four Factor Analysis)?*

Yes

If no, provide an estimated date when the agency will perform an LEP Assessment.*

Does the agency perform the LEP Assessment annually?*

Yes

If yes, please share findings, results or trends.*

If no, please explain why the agency does not perform annual LEP Assessments.*

Does the LEP Assessment address the four factors identified in the U.S. Department of Transportation LEP Guidance?*

U.S. Department of Transportation LEP Guidance

Yes

If yes, please share the results of the assessment.*

If no, please explain why the LEP Assessment does not address all four factors.*

Does the agency have a Language Access Plan (LAP) that includes the results of the LEP Assessment?*

Yes

If yes, upload a copy of the LAP at the end of the form or provide a link if available.*

Enter N/A if link isn't available

If no, please explain.*

Is the LAP made available to the public?*

Yes

If yes, how is it made available? Provide a link if available.*

1. Website

2. Made available at an agency facility (Library, City Hall, main office, etc.)

3. Available upon request

4. Other - Please specify.

Language Access Plan Link*

Other - Please Specify*

If no, how does the agency plan to make it available to the public?*

1. Website

2. Made available at an agency facility (Library, City Hall, main office, etc.)

3. Available upon request

4. Other - Please specify.

Other - Please Specify*

Does the agency have procedures for processing interpretation (verbal) or translation (written) requests?*

Yes

If yes, please explain.*

Upload a copy of the procedures or provide a link if available.*

Enter N/A if link isn't available

If no, provide an estimated date when the procedures for processing interpretation or translation requests will be developed.*

Has the agency received any interpretation or translation service requests within the past year?*

Yes

If yes, how many were received and in which languages?*

For example, 5 Interpretations (3 Spanish, 1 Tagalog, and 1 Vietnamese) and 10 Translations (4 Spanish, 3 Chinese, 1 Tagalog, and 2 French).

If no, please explain why the agency did not receive any requests.*

Has the agency provided any interpretation or translation services within the past year?*

Yes

If yes, how many were provided and in which languages?*

If no, please explain why the agency did not provide any interpretation or translation services.*

Does the agency keep a log of interpretation and translation services requested by the public or provided to the public?*

Yes

If yes, upload a copy of the interpretation and translation log in the attachments section at the end of the form.

If no, please explain how the agency keeps track of LEP services requested or provided.*

Public Participation Plan

Does the agency have procedures for engaging the public, including underrepresented and minority communities, in decision-making processes?*

Yes

Dissemination of Title VI Information

(23 CFR 200.9(b)(12))

Has the agency developed Title VI information for dissemination to the general public and, where appropriate, in languages other than English (determined by the LEP Assessment)?*

Yes

If no, provide an estimated date when Title VI materials will be completed.*

Are Title VI information or materials made available to the public?*

Yes

If yes, how is it made available? Include how Title VI information is distributed in other languages. Upload copies of Title VI materials or provide links if available.*

1. Website

2. Postings (Posters, etc.)

3. Handouts (Flyers, brochures, etc.)

4. Other - Please specify.

Title VI Information Link*

Other - Please specify*

If no, when does the agency plan to have Title VI materials distributed?*

Title VI Training to Local Public Agency (LPA) Staff

(23 CFR 200.9(b)(9))

Does the agency provide Title VI training to all local agency employees?*

Yes

If yes, upload a copy of the training and the most recent training roster/sign-in sheets.

If no, provide an estimated date when the Title VI training will be given to employees.*

Does the agency provide Title VI training for its employees every two years?*

Yes

If no, how often is training provided to employees?*

Does the Title VI training cover what is Title VI, how the local agency implements its Title VI program to meet federal requirements, and what steps to take for handling Title VI complaints, as well as language interpretation (verbal)/translation (written) requests?*

Yes

If no, please explain what is missing from the Title VI training.*

Title VI Assurances in Contract Documents and Agreements

(23 CFR 200.9(a)(1) and 49 CFR 21.7)

Has the agency signed the latest Exhibit 4-C (link below), which includes the Title VI Assurances (Exhibit B of the Master Agreement)?*

Exhibit 4-C, MASTER AGREEMENT - ADMINISTERING AGENCY-STATE AGREEMENT FOR FEDERAL-AID PROJECTS

Yes

If yes, upload the latest signed copy of Exhibit 4-C.

If no, provide an estimated date when the agency will sign the updated Exhibit 4-C.*

Does the agency include required Title VI assurances (specifically, Appendices A and E of the Title VI Assurances) in all sub-contracts and sub-agreements with federal funds?*

Yes

If yes, upload a copy of a construction contract and a consultant contract receiving FHWA funds.

If no, provide an estimated date when the agency will include required Title VI assurances in federally-assisted contracts.*

Title VI Complaint Procedures

(23 CFR 200.9(b)(3))

Does the agency have a Title VI complaint form made available to the public?*

Yes

If yes, upload a copy of the Title VI complaint form or provide a link if available.*

Enter N/A if link is unavailable

If no, provide an estimated date when the Title VI complaint form will be developed and made available to the public.*

Does the agency have a Title VI complaint log?*

Yes

If yes, upload a copy of the Title VI complaint log.

If no, provide an estimated date when the Title VI complaint log will be developed.*

Does the agency have procedures for prompt processing and disposition of Title VI complaints received directly by the agency?*

Yes

If yes, upload a copy of the Title VI complaint procedures or provide a link if available.*

Enter N/A if link is unavailable

If no, provide an estimated date when the Title VI complaint procedures will be developed.*

Does the agency’s Title VI complaint procedures include logging Title VI complaints received and determining jurisdiction, as well as for completeness?*

Yes

If no, provide an estimated date when the Title VI complaint procedures will be updated to include this information.*

Does the agency’s Title VI complaint procedures include forwarding Title VI complaints to Caltrans for processing?*

Yes

If no, provide an estimated date when the Title VI complaint procedures will be updated to include this information.*

Title VI Data Collection

(23 CFR 200.9(b)(4))

Does the agency have procedures for the collection of statistical data (race, color, and national origin) of participants in, and beneficiaries of, federally funded roadway projects?*

Yes

If yes, upload a copy of the Title VI data collection procedures or provide a link if available.*

Enter N/A if link is unavailable

If no, provide an estimated date when the Title VI data collection procedures will be developed.*

Does the agency’s Title VI data collection procedures include procedures for analyzing the data collected to determine the effectiveness of outreach methods, and to ensure that no group is excluded during the decision-making process or is not given an opportunity to voice their opinions or concerns?*

Yes

If yes, upload a copy of the Title VI data collection procedures that include an analysis of the data collected.

If no, provide an estimated date when the Title VI data collection procedures include analyzing the data collected.*

Was Title VI data and analysis conducted within the last year?*

Yes

If yes, upload a copy of the Title VI data collected and analyzed.

If no, please explain why Title VI data was not collected and analyzed.*

Internal/External Title VI Reviews

(23 CFR 200.9(a)(4), 23 CFR 200.9(b)(5), 23 CFR 200.9(b)(6), and 23 CFR 200.9(b)(7))

Does the agency have a program to conduct internal Title VI reviews of program areas?*

Yes

If yes, please explain. Upload a copy of the internal Title VI review procedures if available.*

If no, provide an estimated date when internal Title VI review procedures will be developed.*

When did the agency last conduct an internal Title VI review for Title VI compliance with FHWA’s Title VI requirements?*

What were the results of the review and what actions were taken to ensure Title VI compliance?*

Upload a copy of the results of the internal review if available

Does the agency have a program to conduct external Title VI reviews of sub-awardees (entities receiving FHWA funds through the LPA such as other local agencies, contractors, consultants, etc.)?*

Yes

If yes, please explain. Upload a copy of the external Title VI review procedures if available.*

If no, provide an estimated date when external Title VI review procedures will be developed.*

How often are external Title VI reviews conducted?*

When did the agency last conduct external Title VI reviews of sub-awardees for Title VI compliance with FHWA’s Title VI requirements?*

Which entities were reviewed?*

What were the results of the reviews and what actions were taken to ensure sub-awardees are compliant with Title VI?*

Upload a copy of the results of the external reviews if available

Title VI Accomplishments and Goals Report (Title VI Annual Work Plan)

(23 CFR 200.9(b)(10))

Does the agency have a Title VI Annual Work Plan which consists of accomplishments for the past year, and goals for the next year?*

Yes

If no, provide an estimated date when the Title VI Annual Work Plan will be developed.*

If no, how will the Title VI Annual Work Plan made available to the public?*

Website (include box for providing link)

Available in agency facilities

Available upon request

Other – Please specify (include box for text)

If Other, please specify*

Is the Title VI Annual work plan made available to the public?*

Yes

If yes, how is the Title VI Annual Work Plan made available to the public?*

Website (provide link below)

Available in agency facilities

Available upon request

Other – Please specify

Please upload a copy of the Title VI Annual Work Plan at the end of the form

Title VI Annual Work Plan Link*

If other, please specify*

If no, does the agency plan to post the Title VI Annual Work Plan on their website?*

Yes

If yes, provide estimated date when agency will post Title VI Annual work plan.*

If the agency does not plan to post the Title VI Annual Work Plan, how does the agency plan to make it available to the public?*

1. Made available at an agency facility (Library, City Hall, main office, etc.)

2. Available upon request

3. Other - Please specify.

If other, please specify*

Attachments Section

Upload a copy of the agency’s most recent Title VI Plan.

Upload a copy of the agency’s most recent Title VI/Non-Discrimination Policy Statement.

Upload a copy of the Language Access Plan (LAP) if link was not provided previously.

Upload a copy of the procedures for processing interpretation (verbal) or translation (written) requests? (Executive Order 13166)

Upload a copy of the interpretation and translation log requested by or provided to the public.

Upload copies of Title VI materials or provide links if available.

Upload a copy of the training and training roster/sign-in sheets

Upload the latest signed copy of Exhibit 4-C.

Upload a copy of a construction contract and a consultant contract receiving FHWA funds.

Upload a copy of the Title VI complaint form if available.

Upload a copy of the Title VI complaint log.

Upload a copy of the Title VI complaint procedures if available.

Upload a copy of the Title VI data collection procedures if available.

Upload a copy of the Title VI data collection procedures that include an analysis of the data collected.

Upload a copy of the Title VI data collected and analyzed.

Upload a copy of the internal Title VI review procedures if available.

Upload a copy of the results of the internal reviews if available

Upload a copy of the external Title VI review procedures if available.

Upload a copy of the results of the external reviews if available

Upload a copy of the Title VI Annual Work Plan if available.

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