| Persons are not required to respond to a collection of information unless it displays a currently valid OMB control number. Pursuant to 29 CFR § 37.37(c), completing this log is required to obtain or retain benefits under the Workforce Investment Act of 1998. The Department of Labor's Civil Rights Center will use the information to identify any patterns of discrimination that may exist within a particular program, and to ensure that individuals who file complaints alleging discrimination with the recipient are afforded due process in that the complaint is processed in a accordance with the nondiscrimination and equal opportunity provisions of the Workforce Investment Act of 1998 for complaint processing procedures. Average response time is estimated to be 3 minutes for each compliant entry. Send comments regarding this estimate or any other aspects of this collection of information to the U.S. Department of Labor, Office of the Assistant Secretary for Administration and Management, Civil Rights Center, Room N-4123, Washington, D.C. 20210. Please reference OMB control number 1225-0077. |
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| Date of Complaint |
Name of Complainant |
Address of Complainant |
WIA participant
Employee
Student
Customer
Service Provider
Applicant
Non-Customer
Status of Complainant |
Employment Services;
Unemployment Insurance;
WIA Title I;
TAA
Non- DOL funded Program
DOL-funded Program |
Date of the Alleged Discrimatory Incident |
Grounds/ (Bases) of Complaint |
Description/Issue of Complaint |
Name of Respondent |
Recipients include, but are not limited to: State-level agencies that administer or are financed in whole or part with WIA Title I funds, State Workforce Agencies (Employment Services and Unemployment Insurance-UI), State and Local Workforce Investment Boards LWIA Grant recipients, and One-Stop Operators, Providers of services, and benefits, or training funds, or authorized under WIA, include eligible training providers, On-the-Job (OJT) employers, Job Corps Centers, Job Corps national training contractors, Outreach and admissions agencies, including Job Corps contractors that perform these functions, Placement agencies, including Job Corps contractors that perform these functions, One-Stop partners to extent that they participate in the One-Stop delivery system.
Is Respondent a recipient? Yes or No |
Disposition |
Date of Disposition |
ADR Yes or No |
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