Information Collection

Civil Rights/Conscience Religious Freedom Discrimination Complaint

IC 236663 under ICR 201906-0945-004 · OMB 0945-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0945-0002 can be found here:

Documents and Forms

Document Name Document Type
0945-0002 CR-CRF_Complaint_Forms_508R.pdf Other-form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Civil Rights/Conscience Religious Freedom Discrimination Complaint	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-form			0945-0002 CR-CRF_Complaint_Forms_508R.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,433	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	8,433	8,433
Annual IC Time Burden (Hours)	6,325	6,325
Annual IC Cost Burden (Dollars)	0	0

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.