Information Collection

Individual Complaint of Employment Discrimination

IC 44070 under ICR 201508-2105-002 · OMB 2105-0556.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2105-0556 can be found here:

Documents and Forms

Document Name Document Type
Form DOT F 1050–8 Individual Complaint of Employment Discrimination Form and Instruction
DOT F 1050–8 Individual Complaint of Employment DOT_F_1050–8_One DOT Complaint Form_Blank_JULY 2015.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Individual Complaint of Employment Discrimination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 1614

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DOT F 1050â8	Individual Complaint of Employment	DOT_F_1050â8_One DOT Complaint Form_Blank_JULY 2015.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title: EEOC/GOVT-1 - Equal Employment Opportunity in the Federal Government Complaint and Appeal Records	FR Citation: 67 FR 49354

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	10	0	10
Annual IC Time Burden (Hours)	30	0	30
Annual IC Cost Burden (Dollars)	58	58	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.