Office of Special Counsel for Immigration-Related Unfair Employement Practices Charge Form

Forms and Documents

Document Name	Status
Form OMB Number 1190-00 Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form Form and Instruction	Modified
1190-0018 Consultations Outside the Agency_Charge Form_100914.doc Supplementary Document	2014-10-09
1190-0018_Charge Form - Justification re no expiration date 10 7 2014.doc Supplementary Document	2014-10-09
28 CFR PART 44_021313.pdf Supplementary Document	2013-02-13
8 USC 1324b_021313.pdf Supplementary Document	2013-02-13
1190-0018_83i Form_100914.pdf Supplementary Document	2014-10-09
1190-0018 Supporting Statement_102214.doc Supporting Statement A	2014-10-22

IC Document Collections

IC ID	Document Title	Status
205699	Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form Form and Instruction	Modified

ICR Details

OMB Control No: 1190-0018	ICR Reference No: 201410-1190-001
Status: Historical Active	Previous ICR Reference No: 201302-1190-001
Agency/Subagency: DOJ/CRT	Agency Tracking No:
Title: Office of Special Counsel for Immigration-Related Unfair Employement Practices Charge Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/02/2015
	Date Received in OIRA: 10/22/2014
Terms of Clearance: Previous terms of clearance apply to this approval..

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2016	36 Months From Approved	01/31/2015
Responses	300	0	300
Time Burden (Hours)	150	0	150
Cost Burden (Dollars)	0	0	0

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Abstract: Under 8 U.S.C. § 1324b of the Immigration and Nationality Act, the United States Department of Justice, Civil Rights Division, Office of Special Counsel for Immigration-Related Unfair Employment Practices (OSC) requires information on citizenship status, immigration status, national origin, and the nature, timing, and specifics of the alleged discriminatory acts from charging parties alleging discrimination in order to determine jurisdiction over the allegation of employment discrimination and to initiate an investigation based on the allegation.

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Authorizing Statute(s): US Code: 8 USC 13224b Name of Law: Immigration and Nationality Act
  

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 48765	08/18/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 63166	10/22/2014
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form	OMB Number 1190-0018	OSC Charge Form

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ICR Summary 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	300	300	0	0	0	0
Annual Time Burden (Hours)	150	150	0	0	0	0
Annual Cost Burden (Dollars)	0	0	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: $12,789

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: 10/22/2014

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