Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice

ICR 201404-1190-002

OMB: 1190-0008

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2014-04-09
Supplementary Document
2014-04-09
Supplementary Document
2014-04-09
Supplementary Document
2014-04-08
Supporting Statement A
2014-04-08
ICR Details
1190-0008 201404-1190-002
Historical Active 201302-1190-002
DOJ/CRT
Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice
Revision of a currently approved collection   No
Regular
Approved without change 06/23/2014
Retrieve Notice of Action (NOA) 04/10/2014
  Inventory as of this Action Requested Previously Approved
06/30/2017 36 Months From Approved 06/30/2014
2,000 0 2,000
3,750 0 1,000
0 0 0

Information is used to find jurisdiction to investigate the alleged discrimination, to seek whether a referral to another agency is necessary, and to provide information needed to initiate investigation of the complaint. Respondents are individuals.

US Code: 42 USC 2000d et seq. Name of Law: Title VI of the Civil Rights Act, 1964
   US Code: 28 USC 42.101 rt seq. Name of Law: Antidiscrimination provision of the Omnibus Crime Control and Safe Streets Act
  
None

Not associated with rulemaking

  79 FR 3874 01/23/2014
79 FR 17576 03/28/2014
No

1
IC Title Form No. Form Name
Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice OMB Number 1190-0008, OMB Number 1190-0008, OMB Number 1190-0008, OMB Number 1190-0008, OMB Number 1190-0008 FCS Complaint Consent Korean ,   FCS Complain Consent Vietnamese ,   FCS Complaint Consent Spanish ,   FCS Complaint Consent Chinese ,   Complaint and Consent Form

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,000 2,000 0 0 0 0
Annual Time Burden (Hours) 3,750 1,000 0 0 2,750 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$14,080
No
No
No
No
No
Uncollected
Andrea Plewes 202 353-4107

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/10/2014


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