Americans with Disabilities Act Discrimination Complaint Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1190-0009 can be found here:

Documents and Forms

Document Name Document Type
Form 1190-0009 Americans with Disabilities Act Discrimination Complaint Form Form
1190-0009 Americans with Disabilities Act Discrimination Complaint ADA Discimination Complaint Form.mht www.ada.gov/complaint/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Americans with Disabilities Act Discrimination Complaint Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 35

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1190-0009	Americans with Disabilities Act Discrimination Complaint Form	ADA Discimination Complaint Form.mht	http://www.ada.gov/complaint/	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Prosecution and Litigation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 9,100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	9,100	4,100	5,000
Annual IC Time Burden (Hours)	4,550	800	3,750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.