Individual Complaint of Employment Discrimination

ICR 201612-2105-001

OMB: 2105-0556

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2016-12-02
Supplementary Document
2016-12-02
Supporting Statement A
2016-12-02
Supplementary Document
2012-10-24
Supplementary Document
2009-07-31
IC Document Collections
ICR Details
2105-0556 201612-2105-001
Historical Active 201508-2105-002
DOT/OST
Individual Complaint of Employment Discrimination
Extension without change of a currently approved collection   No
Regular
Approved without change 01/24/2017
Retrieve Notice of Action (NOA) 12/20/2016
  Inventory as of this Action Requested Previously Approved
01/31/2020 36 Months From Approved 01/31/2017
10 0 10
30 0 30
58 0 58

The DOT will utilize the form to collect information necessary to process Equal Employment Opportunity (EEO) discrimination complaints filed by employees, former employees, and applicants for employment with the Department. These complaints are processed in accordance with the Equal Employment Opportunity Commission’s regulations, 29 CFR part 1614, as amended. The DOT will use the form to: (a) request requisite information from the individual for processing his or her EEO employment discrimination complaint; and (b) obtain information to identify an individual or his or her attorney or other representative, if appropriate.

US Code: 42 USC 2000ff Name of Law: PROHIBITING EMPLOYMENT DISCRIMINATION ON THE BASIS OF GENETIC INFORMATION
   PL: Pub.L. 110 - 233 122 STAT. 881 Name of Law: Genetic Information Nondiscrimination Act of 2008.
  
None

Not associated with rulemaking

  81 FR 63855 09/16/2016
81 FR 85685 11/28/2016
No

1
IC Title Form No. Form Name
Individual Complaint of Employment Discrimination DOT F 1050–8 Individual Complaint of Employment

  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 10 10 0 0 0 0
Annual Time Burden (Hours) 30 30 0 0 0 0
Annual Cost Burden (Dollars) 58 58 0 0 0 0
No
No

$2,590,550
No
No
No
No
No
Uncollected
Tami Wright 202 366-9370

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/20/2016


© 2024 OMB.report | Privacy Policy