Information Collection

Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor

IC 13803 under ICR 201406-1250-002 · OMB 1250-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1250-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
cc 4 instructions 19 June 2014 final.docx www.dol.gov/ofccp/regs/compliance/pdf/pdfstart.htm	Instruction
cc-4, revised 1/20 Complaint Involving Employment Discrimination by a Feder CC-4 Form Revised 20 June 2014 final.docx www.dol.gov/ofccp/regs/compliance/pdf/English.pdf	Form
screen shot of webpage for filing complaints.docx Screenshot of OFCCP's Complaint Website	IC Document

IC Title:

Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 41 CFR 60-250.61(b) 41 CFR 60-741.61(c) 41 CFR 60-1.23(a) (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Instruction			cc 4 instructions 19 June 2014 final.docx	http://www.dol.gov/ofccp/regs/compliance/pdf/pdfstart.htm	Yes	No	Printable Only
Form	cc-4, revised 1/2014	Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor	CC-4 Form Revised 20 June 2014 final.docx	http://www.dol.gov/ofccp/regs/compliance/pdf/English.pdf	Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: Complaint Case Files, DOL/ESA-2

FR Citation: 67 FR 16868

Number of Respondents: 747

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	747	0	145	602
Annual IC Time Burden (Hours)	747	-169	145	771
Annual IC Cost Burden (Dollars)	52	0	-231	283

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screenshot of OFCCP's Complaint Website	screen shot of webpage for filing complaints.docx	06/20/2014

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