Information Collection

Americans with Disabilities Act Discrimination Complaint Form

IC 12906 under ICR 201806-1190-001 · OMB 1190-0009.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1190-0009 Americans with Disabilities Act Discrimination Complaint Form	Form
1190-0009 Americans with Disabilities Act Discrimination Complaint ADA Discimination Complaint Form.mht www.ada.gov/complaint/	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 28 CFR 35

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
Form	1190-0009	Americans with Disabilities Act Discrimination Complaint Form	ADA Discimination Complaint Form.mht	http://www.ada.gov/complaint/	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Prosecution and Litigation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,192

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	11,192	2,092	9,100
Annual IC Time Burden (Hours)	8,394	3,844	4,550
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.