Information Collection

OFCCP Complaint Form

IC 13803 under ICR 201101-1250-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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-OFCCP Complain Revised-OFCCP CC-4 Complaint Form-11-16-10.doc	Form and Instruction

IC Title:

OFCCP Complaint Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 41 CFR 60-250.61(b) 41 CFR 60-741.61(c) 41 CFR 60-1.23(a) (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-OFCCP Complaint Form	Revised-OFCCP CC-4 Complaint Form-11-16-10.doc		No		Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: Complaint Case Files, DOL/ESA-2

FR Citation: 67 FR 16868

Number of Respondents: 602

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	602	8	594
Annual IC Time Burden (Hours)	771	11	760
Annual IC Cost Burden (Dollars)	283	22	261

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.