Program Discrimination Complaint Form (Individuals)

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⚠️ Notice: This information collection may be referencing outdated material.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 (Individuals) Form
USDA Program Discrimination Complaint Form USDA complaint form final.docx Form
USDA Program Discrimination Complaint Form Program Complaint Form (Spanish).docx Form

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

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	Program 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: 800	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	800	200	600
Annual IC Time Burden (Hours)	800	200	600
Annual IC Cost Burden (Dollars)	0	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.