Information Collection

Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)

IC 4809 under ICR 201106-0690-002 · OMB 0690-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0690-0015 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CD-498 Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)	Form and Instruction
CD-498 Complaint of Employment Discrimination used by Permanent 0690-0015 OS-CD 498.pdf	Form and Instruction

IC Title:

Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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	CD-498	Complaint of Employment Discrimination used by Permanent Employees and Applicants for Employment at DOC	0690-0015 OS-CD 498.pdf		No		Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	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.