OFCCP Complaint Form

Forms and Documents

Document Name	Status
Form CC-4 OFCCP Complaint Form Form and Instruction	Modified
SS 1215-0131- (CC-4) 10-11-07.doc Supporting Statement A	2007-10-11

IC Document Collections

IC ID	Document Title	Status
13803	OFCCP Complaint Form Form and Instruction	Modified

ICR Details

OMB Control No: 1250-0002	ICR Reference No: 201003-1250-002
Status: Historical Active	Previous ICR Reference No: 200410-1215-002
Agency/Subagency: DOL/OFCCP	Agency Tracking No:
Title: OFCCP Complaint Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/12/2010
	Date Received in OIRA: 03/12/2010
Terms of Clearance: This collection should have been submitted as an ICR Rev.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2011	36 Months From Approved
Responses	594	0	848
Time Burden (Hours)	760	0	1,085
Cost Burden (Dollars)	261	0	0

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Abstract: The complaint form is prepared by individuals who allege illegal discrimination by Federal contractors under any of the three programs administered by OFCCP.

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Authorizing Statute(s): EO: EO 11246 Name/Subject of EO: EEO and AA Guidelines for Federal Contractors Regarding Race, Color, Gender and National Origin
   US Code: 29 USC 793 - Section 503 Name of Law: Section 503- Rehabilitation Act of 1973
   US Code: 38 USC 4212 Name of Law: Vietnam Ear Veterans' Redjustment Assistance Act of 1974
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 39849	07/20/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 58894	10/17/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
OFCCP Complaint Form	CC-4, CC-4	Complaint of Discrimination in Employment Under Federal Government Contracts ,   OFCCP Complaint Form

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	594	848	0	0	-254	0
Annual Time Burden (Hours)	760	1,085	0	0	-325	0
Annual Cost Burden (Dollars)	261	0	0	0	261	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Based on a decrease in the number of complaints received since the last clearance, OFCCP estimates an annual complaint volume of 594. This results in a reduction of burden hours from 1,085 to 760, an adjustment of -325 hours and a reduced annual cost burden of $77.84 ($339.20 - $261.36 = $77.84).

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Annual Cost to Federal Government: $31,855

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/08/2007

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