Discrimination Complaint Form

Complaint of Discrimination Under Section 504, Section 508 or Title VI

OMB: 1405-0220

IC ID: 217700

Documents and Forms
Information Collection (IC) Details

View Information Collection (IC)

Discrimination Complaint Form
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction DS4282 Discrimination Complaint Form Version 1.0 DS4282 3-23-2016.pdf Yes No Fillable Printable

Litigation and Judicial Activities Legal Investigation

 

10 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10 0 10 0 0 0
Annual IC Time Burden (Hours) 10 0 10 0 0 0
Annual IC Cost Burden (Dollars) 10 0 10 0 0 0

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.

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