Information Collection

OFCCP Complaint Form

IC 13803 under ICR 201003-1250-002 · OMB 1250-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1250-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CC-4 OFCCP Complaint Form	Form and Instruction
CC-4 Complaint of Discrimination in Employment Under Federal NewCC-4Wchgs-09-25-07.pdf	Form and Instruction
CC-4 OFCCP Complaint Form CC-4ComplaintForm-06-13-07.pdf www.dol.gov/esa/regs/compliance/ofccp/pdf/pdfstart.htm	Form and Instruction

IC Title:

OFCCP Complaint Form

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 41 CFR 60-1.23(a) 41 CFR 60-250.61(b) 41 CFR 60-741.61(c) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CC-4	Complaint of Discrimination in Employment Under Federal Government Contracts	NewCC-4Wchgs-09-25-07.pdf		Yes	Yes	Fillable Printable
Form and Instruction	CC-4	OFCCP Complaint Form	CC-4ComplaintForm-06-13-07.pdf	http://www.dol.gov/esa/regs/compliance/ofccp/pdf/pdfstart.htm	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: OFCCP Complaint Form

FR Citation: 5 FR 552

Number of Respondents: 594

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 19 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	594	-254	848
Annual IC Time Burden (Hours)	760	-325	1,085
Annual IC Cost Burden (Dollars)	261	261	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.