Program Discrimination Complaint Form (Private Sector)

USDA Program Discrimination Complaint Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0508-0002 can be found here:

Documents and Forms

Document Name Document Type
Program Discrimination Complaint Form (Private Sector) Form
USDA Program Discrimination Complaint Form USDA complaint form final.docx Form
USDA Program Discrimination Complaint Form USDA complaint form spanish.docx Form

Information Collection (IC) Details

IC Title:	Program Discrimination Complaint Form (Private Sector)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 15.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	USDA Program Discrimination Complaint Form	USDA complaint form spanish.docx		Yes	No	Fillable Printable
Form	N/A	USDA Program Discrimination Complaint Form	USDA complaint form final.docx		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 175	Number of Respondents for Small Entity: 20

Affected Public: Private Sector	Private Sector: Farms, Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	175	175
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.