Header and burden notice
OMB Control No. 2900-0883, an estimated burden of 5 minutes and an expiration date of 11/30/2026, followed by the Paperwork Reduction Act notice.
10-0144a
Statement of Assurance of Compliance with Equal Opportunity Laws
- Agency
- VA
- Revision
- December 2023
- Fillable fields
- 9
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0144a: Statement of Assurance of Compliance with Equal Opportunity Laws
VA Form 10-0144a is the U.S. Department of Veterans Affairs Statement of Assurance of Compliance with Equal Opportunity Laws. An organization, institution or individual, which the form calls the Signatory, agrees to comply with Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975 and the Federal regulations adopted to carry out those laws.
The form says the assurance is given for the purpose of obtaining Federal financial assistance. It applies whether assistance is given directly or indirectly through benefits paid to a student, trainee or other beneficiary because of enrollment or participation in a program of the Signatory. Under an agreement between VA and the Department of Education, it also covers assistance given by ED.
The form is one page and ends with the signature, name, title and mailing address of the authorized official. VA's page lists it under VHA. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-0144a
Signatory and the laws covered
The name of the organization, institution or individual, then its agreement to comply with Title VI, Title IX, Section 504 and the Age Discrimination Act. The form lists race, color, national origin, handicap, sex (in education programs and activities only) and age.
Real property
If real property or a structure on it is provided or improved with Federal financial assistance, the assurance obligates the Signatory, or a transferee, for the period it is used for the assisted purpose or a similar one.
Legal basis and enforcement
The Title 38 and Title 10 provisions the assurance is given under, the agreement between VA and ED, and the Signatory's agreement that assistance is extended in reliance on the assurance.
Signature block
Signature of the authorized official, date, name and title of the authorized official, and mailing address of the authorized official.
How to complete VA Form 10-0144a
- 1
Enter the Signatory's name
Type the name of the organization, institution or individual on the line at the top of the form.
- 2
Read the assurance
The text sets out the laws covered, the real property terms, the legal basis and the enforcement terms the Signatory agrees to.
- 3
Sign and date it
The authorized official signs and dates the form in the spaces at the bottom.
- 4
Add the official's details
Enter the authorized official's name and title and mailing address, then download the completed PDF.
Why fill Form 10-0144a on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where it goes
Return address
The form does not print a mailing address or a way to submit it.
Time to complete
The form estimates an average of 5 minutes, including the time to read instructions, gather the necessary facts and fill out the form.
Edition
The PDF footer reads VA FORM DEC 2023 10-0144A. VA's form page lists a revision date of September 2006. The form carries OMB Control No. 2900-0883, which expires 11/30/2026.
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Who uses VA Form 10-0144a?
The form is signed for the organization, institution or individual giving the assurance. It names these parties.
Official sources and the blank
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Questions about Form 10-0144a
What is VA Form 10-0144a?
It is the Statement of Assurance of Compliance with Equal Opportunity Laws. The Signatory agrees to comply with Title VI, Title IX, Section 504 and the Age Discrimination Act in programs receiving Federal financial assistance or other benefits under statutes administered by VA, ED or any other Federal agency.
Who signs VA Form 10-0144a?
The form says the person whose signature appears on it is authorized to sign the assurance for the Signatory, the organization, institution or individual named at the top.
How long does the assurance last?
The form says it is binding on the Signatory, its successors, transferees and assignees for the period during which assistance is provided. For real property, it lasts for the period the property is used for the assisted purpose or a similar one.
Does it cover Department of Education assistance?
Yes. The form says that under an agreement between VA and ED, the assurance also includes Federal financial assistance given by ED through programs administered by that agency.
Where is VA Form 10-0144a sent?
The form does not print a mailing address or say how to send it.
How long does it take to fill out?
The form estimates an average of 5 minutes, including reading the instructions, gathering the facts and filling out the form.