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Appendix D - NCDOT ' s Compliance Review Checklist for Transit <br /> I . Program Administration ( General Requirements ) <br /> Requirement: FTA C4702. 1B — Title Vi Requirements and Guidelines for FTA Recipients, Chapter 111 — General Requirements and Guidelines. <br /> Note : Every NCDOT subrecipient receiving any of the FTA Formula Grants listed above must complete this section . <br /> Requested Items <br /> ( Please attach electronic documents ( . pdf, . doc, etc . ) or provide links to online versions) Completed <br /> 1 . A copy of the recipient' s signed NCDOT' s Title VI Nondiscrimination Agreement El <br /> 2 . Title VI Policy Statement (signed) EJ <br /> 3 . Title VI Notice to the Public, including a list of locations where the notice is posted El <br /> 4 . Type the name and title of your Title VI Coordinator and attach a list of their Title VI ' duties <br /> Name/Title : <br /> 5 . Title VI Complaint Procedures ( i . e . , instructions to the public regarding how to file a Title VI <br /> discrimination complaint ) <br /> 6 . Title VI Complaint Form <br /> 7 . List of transit- related Title VI investigations, complaints, and lawsuits ( i . e . , discrimination <br /> complaints log ) <br /> 8 . Public Participation Plan , including information about outreach method's to engage traditionally' <br /> underserved constituencies ( e . g . , minorities, limited English proficient ' populations ( LEP ) , low <br /> income, disabled ) , as well as a summary `of outreach ` efforts made since the last Title VI Program <br /> submission <br /> 9 . Language Assistance Plan for providing language assistance to persons with limited English <br /> proficiency ( LEP ) , based on the DOT LEP Guidance, which requires conducting four-factor analyse <br /> 10 . A table depicting the membership of non- elected committees and councils, the membership o <br /> which is selected by the recipient, broken down by race, and a description of the process the <br /> agency uses to encourage the participation of minorities on such committees <br /> 11 . A copy of board meeting minutes, resolution , or other appropriate documentation showing the <br /> board of directors or appropriate governing entity or official ( s ) responsible for policy decisions El <br /> reviewed and approved the Title VI Program <br /> 12 . A description of the procedures the agency uses to ensure nondiscriminatory administration o <br /> programs and services <br /> 13 . If you pass through FTA funds to other organizations, include a description of how you <br /> monitor your subrecipients for compliance with Title VI , and a schedule for your subrecipients' <br /> Title VI Program submissions . <br /> r No Subrecipients f—I <br /> 14 . A Title VI equity analysis if you have constructed or conducted planning for a facility, such as a <br /> vehicle storage facility, maintenance facility, operation center,, etc . <br /> No 'Facilities Planned or Constructed <br /> 15 . Copies of environmental justice assessments conducted for any construction projects during the <br /> past three years and , if needed based on the results, a description of the program or other <br /> measures used or planned to mitigate any identified adverse impact on the minority or low El <br /> income communities <br /> No Construction Projects <br />