Prepared by University of Nebraska at Omaha in Collaboration with the Nebraska Department of Roads

1. 5311 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.

2. 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.
Stored in English and Spanish in each service vehicle for upon-request distribution.
Stored in English and Spanish 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.
Stored in English and Spanish in each service vehicle for upon-request distribution.
Stored in English and Spanish at each branch office for upon-request distribution.

3. Part B: Public Participation Plan
When you are announcing and holding a public hearing, your public hearing announcement should:
Be posted twice in the local newspaper (14-21 days in advance and 5-12 days in advance)
Contain one of the paragraphs from the “Public Participation Add-On” located on the last page of
this document.
As part of your Public Participation Plan, you must:
Translate public meeting minutes or other publically-distributed, project-related documents into
Spanish in the event that such translations are requested by a member of the public. Example: if
you distribute a public survey regarding a fare change, and a Spanish-speaking person requests a
copy of the survey in Spanish, you should request a translation from NDOR. Note: you are not
required to translate all public hearing documents ahead of time.
If you are posting a Public Announcement that does not require a public hearing, your public notice should:
Be posted twice in the local newspaper (14-21 days in advance and 5-12 days in advance)
Contain one of the paragraphs from the “Public Participation Add-On” located at the end of this
document.
Information on your services should be posted in Spanish in one or more of the following locations (note: if
you do not meet the LEP threshold of 1,000 or more LEP persons or 5% of your service area, this
requirement does not apply):
Online
In print within the agency service vehicles
In print in one or more public locations selected with regard to their visibility to minority of limited
English proficient persons (e.g., gas stations, grocery stores, service stops, community centers,
etc.).

4. Part C: Language Assistance Plan
Necessary personnel are trained to use LanguageLine and “I Speak” Cards.
All personnel are familiar with the agency’s Title VI Complaint Procedures
Publically-released documents surrounding a public hearing or announcement are translated into
Spanish upon request.
Reasonable effort is made to translate other documents into Spanish upon request from the public.

5. Part D: Employee Training
All transit personnel have read the agency’s Title VI Plan and signed the Employee Training Form
Necessary personnel are trained to use LanguageLine and “I Speak” cards.
All personnel are familiar with agency’s Title VI complaint procedures.
An agency staff member has attended Title VI training (not mandatory, but recommended).

6. Public Participation Add-On
As part of your Public Participation Plan, Include one of the following paragraphs (A, B , C, or D) in Spanish
at the bottom of your public hearing announcement or public notice in the newspaper. They are in English
here only so that you can read them. Use Google translate to fill in the blanks, such as “application for
operating assistance.”
 Paragraphs A and B are for notices to the public of an upcoming public hearing.
 Paragraphs C and D are for announcements that do not include a public hearing.
NOTE: You should choose paragraphs B or D only if you plan to translate public meeting documents and
make them available on your website and ahead of time. Otherwise, choose paragraph A or C.
If you have questions about this portion of your Title VI Plan, please call Aaron Mack at (402)-805-
3300, or Franchell Abdalla at (402)-554-6037.
A: (use this or “B” for public hearing notices)
Este anuncio contiene información sobre una audiencia pública que se llevará a cabo por (insert agency)
en (insert date and time) a (insert address). El propósito de esta audiencia es para discutir
_________________. Para obtener una copia traducida de este aviso, o de otros documentos liberados
públicamente relacionados con esta audiencia, incluyendo minutos de las reuniones, favor de ponerse en
contacto por teléfono al (insert telephone number). Un intérprete será proporcionado para asistir a usted.
This announcement contains information regarding a public hearing to be held by (insert agency name) on
(insert date and time) at (insert address). The purpose of this hearing is to discuss _________________.
To request a translated copy of this announcement, or of other publically-released documents related to
this hearing, including meeting minutes, please contact the agency by phone at (insert telephone number).
An interpreter will be provided to assist you.
B: (use this or “A” for public hearing notices)
Este anuncio contiene información sobre una audiencia pública que se llevará a cabo por (insert agency
name) en (insert date and time) a (insert address). El propósito de esta audiencia es para discutir
_________________. Para obtener una copia traducida de este anuncio, o de otros documentos liberados
públicamente relacionados con esta audiencia, incluyendo minutos de las reuniones, favor de visitar el sitio
de web a www.www.www, o por teléfono al (insert telephone number). Un intérprete será proporcionado
para asistir a usted.
This announcement contains information regarding a public hearing to be held by (insert agency) on (insert
date and time) at (insert address). The purpose of this hearing is to discuss ____________________. To
obtain a translated copy of this announcement, or of other publically-released documents related to this
hearing, including meeting minutes, please visit the agency website at www.www.www, or contact the
agency by phone at (insert number), and an interpreter will be provided to assist you.

7. C: (use this or “D” for public announcements that do not include a public hearing)
This is a public notice by (insert agency name) to announce ___________________. To request a
translated copy of this announcement, or to make a comment or request more information, please contact
the agency by phone at (insert telephone number). An interpreter will be provided to assist you.
Esto es un aviso público por (insert agency name) para anunciar ___________________. Para solicitar
una copia traducida de este anuncio, o para hacer un comentario o pedir más información, favor de
ponerse en contacto con la agencia por teléfono al (insert telephone number). Un intérprete será
proporcionado para asistir a usted.
D: (use this or “C” for public announcements that do not include a public hearing)
This is a public notice by (insert agency name) to announce ___________________. To obtain a translated
copy of this announcement, please visit the agency website at (insert web address). To make a comment
or request more information, please contact the agency by phone at (insert number), and an interpreter will
be provided to assist you.
Esto es un aviso público por (insert agency name) para anunciar ___________________. Para solicitar
una copia traducida de este anuncio, favor de visitar el sitio de web de la agencia a www.www.www. Para
hacer un comentario o pedir más información, favor de ponerse en contacto con la agencia por teléfono al
(insert telephone number). Un intérprete será proporcionado para asistir a usted.