Workplace Discrimination Complaints

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3060-1237 can be found here:

Documents and Forms

Document Name Document Type
Form FCC 5621 Workplace Discrimination Complaints Form
FCC 5621 Pre-Complaint Form for Discrimination Pre-Complaint Form Final OMB.pdf Form
FCC 5622 Formal Complaint for Discrimination Formal Complaint Final OMB.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Workplace Discrimination Complaints	Agency IC Tracking Number:	OWD

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 1614.105 29 CFR 1614.106

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FCC 5621	Pre-Complaint Form for Discrimination	Pre-Complaint Form Final OMB.pdf		Yes	Yes	Fillable Fileable Signable
Form	FCC 5622	Formal Complaint for Discrimination	Formal Complaint Final OMB.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	26	26
Annual IC Time Burden (Hours)	91	91
Annual IC Cost Burden (Dollars)	15,000	15,000

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.