Individual Complaint of Employment Discrimination

⚠️ Notice: This information collection may be referencing outdated material.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 secure.dot.gov/form/eeoc 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 1050–8	Individual Complaint of Employment	DOT_F_1050–8_One DOT Complaint Form_Blank_JULY 2015.docx	https://secure.dot.gov/form/eeoc	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	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	58	58

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.