Information Collection

Compliant Information

IC 183761 under ICR 201709-1225-001 · OMB 1225-0077.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0077 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
PRA Attchment 12 - Sample Discrimination Complaint Form (Final_20171030).docx	Other-Prototype Form
Discrimination ComplaintLogInstructions (Final_20171030).docx	Instruction
DL-2014A Compliant Information Form PRA Attchment 8-Complaint Information and Privacy Act Form.pdf www.dol.gov/oasam/programs/crc/external-enforc-complaints.htm	Form
PRA Attchment 12 - Sample Discrimination Complaint Form (Tracked_20171030).docx Track Changes Complaint Form	IC Document
Discrimination ComplaintLogInstructions (Tracked_20171030).docx Track Changes PRA Attchment 12 - Sample Discrimination Complaint Log Instructions	IC Document

IC Title:

Compliant Information

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 38.70 29 CFR 37.74 29 CFR 38.73 29 CFR 37.73(a)-(d) 29 CFR 38.72 29 CFR 38.74 29 CFR 38.80

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Prototype Form			PRA Attchment 12 - Sample Discrimination Complaint Form (Final_20171030).docx		Yes	No	Paper Only
Form	DL-2014A	Compliant Information Form	PRA Attchment 8-Complaint Information and Privacy Act Form.pdf	http://www.dol.gov/oasam/programs/crc/external-enforc-complaints.htm	Yes	Yes	Fillable Printable
Instruction			Discrimination ComplaintLogInstructions (Final_20171030).docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: DOL/OASAM-22

FR Citation: 67 FR 16816

Number of Respondents: 35,099

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 15 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35,099	33,259	1,840
Annual IC Time Burden (Hours)	35,099	33,259	1,840
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Track Changes Complaint Form	PRA Attchment 12 - Sample Discrimination Complaint Form (Tracked_20171030).docx	10/31/2017
Track Changes PRA Attchment 12 - Sample Discrimination Complaint Log Instructions	Discrimination ComplaintLogInstructions (Tracked_20171030).docx	10/31/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.