Information Collection

Program Discrimination Complaint Form (Individuals)

IC 987 under ICR 201409-0508-001 · OMB 0508-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0508-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Program Discrimination Complaint Form (Individuals)	Form
USDA Program Discrimination Complaint Form USDA complaint form final.docx	Form
USDA Program Discrimination Complaint Form Program Complaint Form (Spanish).docx	Form

IC Title:

Program Discrimination Complaint Form (Individuals)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 15.6

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	N/A	USDA Program Discrimination Complaint Form	USDA complaint form final.docx		Yes	No	Fillable Printable
Form	N/A	USDA Program Discrimination Complaint Form	Program Complaint Form (Spanish).docx		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 800

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	800	800
Annual IC Time Burden (Hours)	800	800
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.