Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Nonmaterial Change Justification 8 28 2015.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2015-08-28	Available
CC-4 Supporting_Statement CC-4 23 June 2014.docx	Supporting Statement A	Uploaded 2014-06-23	Available
41 CFR Part 60-741.doc	Supplementary Document	Uploaded 2011-01-20	Available
41 CFR Part 60-300.doc	Supplementary Document	Uploaded 2011-01-20	Available
41 CFR Part 60-250.doc	Supplementary Document	Uploaded 2011-01-20	Available
41 CFR Part 60-4.doc	Supplementary Document	Uploaded 2011-01-20	Available
41 CFR Part 60-2.doc	Supplementary Document	Uploaded 2011-01-20	Available
41 CFR PART 60-1.doc	Supplementary Document	Uploaded 2011-01-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13803	Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor	Instruction	Modified

ICR Details

OMB Control No: 1250-0002	ICR Reference No: 201409-1250-007
Status: Historical Active	Previous ICR Reference No: 201406-1250-002
Agency/Subagency: DOL/OFCCP	Agency Tracking No:
Title: Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/19/2015
	Date Received in OIRA: 10/17/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2017	08/31/2017	08/31/2017
Responses	747	0	747
Time Burden (Hours)	747	0	747
Cost Burden (Dollars)	52	0	52

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Abstract: The complaint form is prepared by individuals who allege illegal discrimination by Federal contractors under any of the three programs administered by OFCCP. OFCCP is requesting approval of a non-material change to its complaint form. OFCCP has translated its forms into Spanish, Chinese, French, Korean, and Vietnamese.

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Authorizing Statute(s): US Code: 38 USC 4212 Name of Law: Vietnam Era Veterans' Readjustment Assistance Act of 1974
   EO: EO 11246 Name/Subject of EO: EEO and AA Guidelines for Federal Contractors Regarding Race, Color, Gender and National Origin
   US Code: 29 USC 793 - Section 503 Name of Law: Section 503- Rehabilitation Act of 1973
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 6924	02/05/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 36335	06/26/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor	CC-4, CC-4, CC-4, CC-4, CC-4, CC-4	Complaint Involving Employment Discrimination by Federal Contractors or Subcontractors (French) ,   Complaint Involving Employment Discrimination by Federal Contractors or Subcontractors (Korean) ,   Complaint Involving Employment Discrimination by Federal Contractors or Subcontractors (Spanish) ,   Complaint Involving Employment Discrimination by Federal Contractors or Subcontractors (Chinese - Simplified) ,   Complaint Involving Employment Discrimination by Federal Contractors or Subcontractors (Chinese - Traditional) ,   Complaint Involving Employment Discrimination by Federal Contractors or Subcontractors (Vietnamese)

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ICR Summary of Burden

table that charts list of burden

	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	747	747	0	0	0	0
Annual Time Burden (Hours)	747	747	0	0	0	0
Annual Cost Burden (Dollars)	52	52	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $54,165

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/17/2015

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