Information Collection

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

IC 12903 under ICR 201404-1190-002 · OMB 1190-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1190-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OMB Number 1190-00 Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice	Form and Instruction
OMB Number 1190-00 FCS Complaint Consent Korean 1190-0008_2011_FCS_Complaint_Consent_Korean.pdf www.justice.gov/crt/complaint/#five	Form and Instruction
OMB Number 1190-00 FCS Complain Consent Vietnamese 1190-0008_2011_FCS_Complaint_Consent_Vietnamese.pdf www.justice.gov/crt/complaint/#five	Form and Instruction
OMB Number 1190-00 FCS Complaint Consent Spanish 1190-0008_2013_FCS_Complaint_Consent_Spanish.pdf www.justice.gov/crt/complaint/#five	Form and Instruction
OMB Number 1190-00 FCS Complaint Consent Chinese 1190-0008_complaint_consent_chinese_2011.pdf www.justice.gov/crt/complaint/#five	Form and Instruction
OMB Number 1190-00 Complaint and Consent Form Complaint_and_Consent_April2014.pdf	Form and Instruction
COR regs complaint form consent form.pdf COR Regulations	IC Document
Electronic Code of Federal Regulations Title 28 Judicial Adminstration.pdf Electronic Code of Federal Regulations Title 28 Judicial Administration	IC Document

IC Title:

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

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	OMB Number 1190-0008	FCS Complaint Consent Korean	1190-0008_2011_FCS_Complaint_Consent_Korean.pdf	http://www.justice.gov/crt/complaint/#five	Yes	No	Printable Only
Form and Instruction	OMB Number 1190-0008	FCS Complain Consent Vietnamese	1190-0008_2011_FCS_Complaint_Consent_Vietnamese.pdf	http://www.justice.gov/crt/complaint/#five	Yes	No	Printable Only
Form and Instruction	OMB Number 1190-0008	FCS Complaint Consent Spanish	1190-0008_2013_FCS_Complaint_Consent_Spanish.pdf	http://www.justice.gov/crt/complaint/#five	Yes	No	Printable Only
Form and Instruction	OMB Number 1190-0008	FCS Complaint Consent Chinese	1190-0008_complaint_consent_chinese_2011.pdf	http://www.justice.gov/crt/complaint/#five	Yes	No	Printable Only
Form and Instruction	OMB Number 1190-0008	Complaint and Consent Form	Complaint_and_Consent_April2014.pdf		Yes	No	Printable Only

Line of Business: Law Enforcement

Subfunction: Citizen Protection

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

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	2,000	0	2,000
Annual IC Time Burden (Hours)	3,750	2,750	1,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
COR Regulations	COR regs complaint form consent form.pdf	07/25/2007
Electronic Code of Federal Regulations Title 28 Judicial Administration	Electronic Code of Federal Regulations Title 28 Judicial Adminstration.pdf	07/26/2007

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.