Unfair Immigration-Related Employment Practices Complaint Form

Forms and Documents

Document Name	Status
Form EOIR-58 Unfair Immigration-Related Employment Practices Complaint Form Form and Instruction	Unchanged
Revised Form EOIR-58 (OMB1125-0016).pdf Supplementary Document	2017-03-21
Revised Form EOIR-58 (OMB1125-0016) Spanish Instructions.pdf Supplementary Document	2017-03-21
Revised Form EOIR-58 (OMB1125-0016) English Instructions.pdf Supplementary Document	2017-03-21
Current Form EOIR-58 (OMB1125-0016).pdf Supplementary Document	2017-03-21
EOIR-58 (OMB 1125-0016) Narrative of Changes.pdf Supplementary Document	2017-03-21
Form EOIR-58 (OMB 1125-0016) Additional Instructions (Spanish).pdf Supplementary Document	2016-03-29
Form EOIR-58 (OMB 1125-0016) Additional Instructions (English).pdf Supplementary Document	2016-03-29
EOIR-58 (OMB 1125-0016) Narrative of Changes.pdf Justification for No Material/Nonsubstantive Change	2016-03-29
Currently Approved Form EOIR-58 (OMB 1125-0016).pdf Supplementary Document	2016-03-29
E-58 Cover Letter to Lynn Murray.pdf Supplementary Document	2015-09-25
E-58 30 day FR notice Posted 2015-17697[1].pdf Supplementary Document	2015-07-21
5. 8 USC 1324b.pdf Supplementary Document	2015-07-15
4. E-58 OCAHO Complaint Form 83i-fill.pdf Supplementary Document	2015-07-15
1. E-58 Cover Letter to Lynn Murray.pdf Supplementary Document	2015-07-15
REVISED SUPPORTING STATEMENT 2015 OCAHO Complaint Form EOIR-58.pdf Supporting Statement A	2015-09-25
E-58 60 day FR Notice 2015-12313.pdf Supplementary Document	2015-05-26

IC Document Collections

IC ID	Document Title	Status
217474	Unfair Immigration-Related Employment Practices Complaint Form Form and Instruction	Unchanged

ICR Details

OMB Control No: 1125-0016	ICR Reference No: 201703-1125-001
Status: Historical Active	Previous ICR Reference No: 201603-1125-006
Agency/Subagency: DOJ/EOIR	Agency Tracking No: EOIR-58
Title: Unfair Immigration-Related Employment Practices Complaint Form
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/25/2017
	Date Received in OIRA: 04/13/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	11/30/2018	11/30/2018
Responses	22	0	22
Time Burden (Hours)	22	0	22
Cost Burden (Dollars)	1,436	0	1,436

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Abstract: Section 274B of the INA prohibits: employment discrimination on the basis of citizenship status or national origin; retaliation or intimidation by an employer against an individual seeking to exercise his or her rights under this section; and "document abuse" or overdocumentation by the employer, which occurs when the employer asks an applicant or employee for more or different documents than required for employment eligibility verification under INA section 274A, with the intent of discriminating against the employee in violation of section 274B.

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Authorizing Statute(s): US Code: 8 USC 1324b Name of Law: INA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 29340	05/21/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 42840	07/20/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Unfair Immigration-Related Employment Practices Complaint Form	EOIR-58	Unfair Immigration-Related Employment Practices Complaint Form

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ICR Summary of Burden

	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	22	22	0	0	0	0
Annual Time Burden (Hours)	22	22	0	0	0	0
Annual Cost Burden (Dollars)	1,436	1,436	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $703

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 04/13/2017

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