Persons
are not required to respond to a collection of information unless
it displays a currently valid OMB control number. Pursuant to 29
CFR § 37.37(c), completing this log is required to
obtain or retain benefits under the Workforce Investment Act of
1998. The Department of Labor's Civil Rights Center will use the
information to identify any patterns of discrimination that
may exist within a particular program, and to ensure that
individuals who file complaints alleging discrimination with the
recipient are afforded due process in that the complaint is
processed in a accordance with the nondiscrimination and equal
opportunity provisions of the Workforce Investment Act of 1998
for complaint processing procedures. Average response time is
estimated to be 3 minutes for each compliant entry. Send comments
regarding this estimate or any other aspects of this collection
of information to the U.S. Department of Labor, Office of the
Assistant Secretary for Administration and Management, Civil
Rights Center, Room N-4123, Washington, D.C. 20210. Please
reference OMB control number 1225-0077 expiration date
07/31/2014.
|
Date
of Complaint
|
Name
of Complainant
|
Address
of Complainant
|
Status
of Complainant
|
DOL-funded
Program
|
Date
of the Alleged Discriminatory Incident
|
Grounds/
(Bases) of Complaint
|
Description/Issue
of Complaint
|
Name
of Respondent
|
Is
Respondent a recipient? Yes or No
|
Disposition
|
Date
of Disposition
|
ADR
Yes or No
|