OMB Justification 2017 Program Complaint Form 0508-0002

U.S. Department of Agriculture

Supporting Statement

USDA Program Complaint

OMB Number: 0508-0002

1. Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.

Under 7 CFR 15.6 “any person who believes himself or any specific class of individuals to be subjected to discrimination…may by himself or by an authorized representative file a written complaint based on the ground of such discrimination.” The collection of this information is the avenue by which the individuals or their representatives may file such a complaint. The requested information is necessary in order for the USDA’s Office of the Assistant Secretary for Civil Rights (OASCR) to address the alleged discriminatory action.

2. Indicate how, by whom, how frequently, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.

The requested information, which can be submitted by completing a form or by submitting a letter, is necessary in order for OASCR to address the alleged discriminatory action. The respondent is asked to state his/her name, mailing address, property address (if different from mailing address), telephone number, email address (if any) and to provide a name and contact information for the respondent’s representative (if any.)

A brief description of who was involved with the alleged discriminatory action, what occurred and when, is requested. In the event that the respondent is filing the program discrimination complaint more than 180 days after the alleged discrimination occurred, the respondent is asked to provide the reason for the delay.

The respondent is asked to identify which bases are alleged to have motivated the discriminatory action (of those bases prohibited under either 7 C.F.R. 15d.2: race, color, national origin, age, sex, disability, religion, sexual orientation, marital or familial status, or because all or part of the individual’s income is derived from any public assistance program; or under nondiscrimination regulations applying to recipients of Federal financial assistance from USDA: race, color, national origin, sex, age, disability, religion or political beliefs.) (Not all bases apply to all programs.)

Finally, the respondent is asked to provide information about what would be required to resolve the complaint, from his or her perspective, as well as information about whether the respondent has previously filed a complaint about the incident in another forum.Show citation box

OASCR uses the information provided by the respondent to evaluate, investigate, and, as appropriate, attempt resolution and settle the case. The information format in the submitted collection of document is provided to the public to assist in gathering the necessary information to open a program discrimination complaint case in a manner most efficient and least intrusive for the public/customer.

3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also, describe any consideration of using information technology to reduce burden.

This form can also be downloaded from the USDA website, completed and submitted by fax or mail. The information provided will be entered into an OASCR electronic system of records, although the original document(s) submitted by the respondent will be retained in hard copy.

4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purpose described in item 2 above.

Each allegation of discrimination is unique and the circumstances surrounding the alleged actions must be recorded separately. No other agency or group is collecting this information.

5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.

Approximately 20 small businesses or entities will use this form each year. The submission of information regarding alleged discrimination is of a minimum burden and is of the same intensity for any member of the public/customer who wishes to submit a complaint.

6. Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.

If information regarding alleged discrimination is not collected from the individual who believes he/she has experienced discrimination in a USDA program, it would be impossible for the USDA to address and rectify the alleged discrimination.

7. Explain any special circumstances that would cause an information collecti­on to be con­ducted in a manner:

• requiring respondents to report informa­tion to the agency more often than quarterly;

• requiring respondents to prepare a writ­ten response to a collection of infor­ma­tion in fewer than 30 days after receipt of it;

• requiring respondents to submit more than an original and two copies of any docu­ment;

• requiring respondents to retain re­cords, other than health, medical, governm­ent contract, grant-in-aid, or tax records for more than three years;

• in connection with a statisti­cal sur­vey, that is not de­signed to produce valid and reli­able results that can be general­ized to the uni­verse of study;

• requiring the use of a statis­tical data classi­fication that has not been re­vie­wed and approved by OMB;

• that includes a pledge of confiden­tiali­ty that is not supported by au­thority estab­lished in statute or regu­la­tion, that is not sup­ported by dis­closure and data security policies that are consistent with the pledge, or which unneces­sarily impedes shar­ing of data with other agencies for com­patible confiden­tial use; or

• requiring respondents to submit propri­etary trade secret, or other confidential information unless the agency can demon­strate that it has instituted procedures to protect the information's confidentiality to the extent permit­ted by law.

There are no special circumstances. The collection is conducted in a manner consistent with guidelines in 5 CFR 1320.5.

8. If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the agency's notice, soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments.

Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting form, and on the data elements to be recorded, disclosed, or reported.

1. Federal Register Notice: A Federal Register Notice requesting public comments on this information collection was published August 25, 2017 (82 FRDOC_0001-1720; Document Number 2017-18021.) No comments were received.

2. Consultation with persons outside the agency: OASCR has not consulted with anyone outside of the agency.

8. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

No payment to or gift will be provided to individuals for responding.

10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

The information provided on this form will only be shared with persons who have an official need to know, and will be protected from public disclosure pursuant to the provisions of the Privacy Act, 5 U.S.C. § 552a(b) (Privacy Act). In accordance with the Privacy Act OASCR maintains a system of records which contains complaints alleging discrimination in USDA program and Equal Employment Opportunities (EEO) programs and activities. This system is currently being modified to address updates to the system location, categories of records, routine uses, one of which permits records to be provided to the National Achieves and Records Administration, storage, safeguards, retention and disposal, system manager and address, notification procedures, records access and contesting procedures.

10. Provide additional justification for any questions of a sensitive nature, such as sexual behavior or attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

Under 7 C.F.R 15.6, “Any person who believes himself/herself or any specific class of individuals to be subjected to discrimination [in any USDA assisted program or activity]… may by himself/herself or by an authorized representative file… a written complaint.” Under 7 C.F.R. 15d.4, “Any person who believes that he or she (or any specific class of individuals) has been, or is being, subjected to [discrimination in any USDA conducted program or activity]… may file on his or her own, or through an authorized representative, a written complaint alleging such discrimination.” The collection of this information is an avenue by which the individual or his representative may file such a program discrimination complaint.

The requested information, which can be submitted by filling out a form or by submitting a letter, is necessary in order for the USDA OASCR to address the alleged discriminatory action. The respondent is asked to state his/her name, mailing address, property address (if different from mailing address), telephone number, email address (if any) and to provide a name and contact information for the respondent’s representative (if any.)

A brief description is requested of who was involved with the alleged discriminatory action, what and when it occurred. In the event that the respondent is filing the program discrimination complaint more than 180 days after the alleged discrimination occurred, the respondent is asked to provide the reason for the delay.

The respondent is asked to identify which bases are alleged to have motivated the discriminatory action (of those bases prohibited under either 7 C.F.R. 15d.2: race, color, national origin, age, sex, disability, religion, sexual orientation, marital or familial status, or because all or part of the individual’s income is derived from any public assistance program; or under nondiscrimination regulations applying to recipients of Federal financial assistance from USDA: race, color, national origin, sex, age, disability, religion or political beliefs.) (Not all bases apply to all programs.)

Finally, the respondent is asked to provide information about what would be required to resolve the complaint, from his or her perspective, as well as information about whether the respondent has previously filed a complaint about the incident in another forum.Show citation box

The program discrimination complaint filing information, which is voluntarily provided by the respondent, will be used by the staff of USDA OASCR to intake, investigate, and adjudicate the respondent’s complaint. The program discrimination complaint form will enable OASCR to better collect information from complainants in a timely manner, therefore reducing delays and errors in determining USDA jurisdiction.

In addition, the respondent is asked voluntarily to provide his or her race, ethnicity, gender, and national origin. This information will be used to help USDA monitor enforcement of laws that require equal access to its programs for eligible persons.

10. Provide estimates of the hour burden of the collection of information. The statement should:

• Indicate the number of respondents, frequency of response, annual hour burden, and an explanation of how the burden was estimated. If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB Form 83-I.

• Provide estimates of annualized cost to respondents for the hour burdens for collections of information, identifying and using appropriate wage rate categories.

The number of respondents per year is estimated to be 141. The hour burden for the respondent is one hour per response.

The cost burden for the respondent at an average hourly wage of $35.28 multiplied by the average number of program complaint forms received by the user population would total $4,974.

10. Provide estimates of the total annual cost burden to respondents or record keepers resulting from the collection of information, (do not include the cost of any hour burden shown in items 12 and 14). The cost estimates should be split into two components: (a) a total capital and start-up cost component annualized over its expected useful life; and (b) a total operation and maintenance and purchase of services component.

There is no capital or startup costs, nor operation/maintenance costs to respondents.

14. Provide estimates of annualized cost to the Federal government. Also, provide a description of the method used to estimate cost and any other expense that would not have been incurred without this collection of information.

The cost to the federal government for the intake of this information is $623. The estimated cost to process each form is based on the assumption that the data from one contact will take 10 minutes to process by a federal employee at a FY 2017 GS-7 Step 5 salary. The Office of Personnel Management states that this salary is $26.53/hr. The cost to process the application is approximately $4.42 per form.

15. Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-1.

This is a revision of a currently approved information collection. There is a change in the number of respondents estimated in 2014. The number cited in this supporting statement shows a decrease from 1000 respondents in 2014 to a projected 141 respondents. The methodology includes a statistical sampling of program complaint participants over the three year period from 2014 through 2016.

16. For collections of information whose results are planned to be published, outline plans for tabulation and publication.

The information received will not be published.

17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

Request is being made not to print the expiration date because this brochure and form will be usable for many years. Having the expiration date on the form respondents may think the expiration date is when their filed complaint expires and they may have to re-file etc.

18. Explain each exception to the certification statement identified in Item 19 "Certification for Paperwork Reduction Act."

The request is in full compliance with the certification statement identified in Item 19.

19. How is this Information collection related to the Customer Service Center.

The Customer Service Center does not receive program complaints. However, they may receive calls and/or e-mails requesting information on how to file a complaint.