Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form OMB 1190-0018 Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form	Form and Instruction	Modified	Available
Memo 1190-0018.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2019-09-19	Available
1190-0018 Published 30 Day Notice.pdf	Supplementary Document	Uploaded 2019-09-18	Available
1190-0018 Supporting Statement 9.18.2019.docx	Supporting Statement A	Uploaded 2019-09-18	Available
Memo - Charge Form Corrected First Page.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2017-02-08	Available
1190-0018 Charge Form Corrected First Page.pdf	Supplementary Document	Uploaded 2017-02-08	Available
Memo ROCIS.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2017-01-18	Available
Charge Form_Name Change Update.pdf	Supplementary Document	Uploaded 2017-01-18	Available
1190-0018_OMB 83i Form OSC_061516.pdf	Supplementary Document	Uploaded 2016-06-16	Available
1190-0018_Consultations Outside the Agency_061616.doc	Supplementary Document	Uploaded 2016-06-16	Available
1190-0018 Justification re no expiration date_061516.doc	Supplementary Document	Uploaded 2016-06-16	Available
28 CFR PART 44_021313.pdf	Supplementary Document	Uploaded 2013-02-13	Available
8 USC 1324b_021313.pdf	Supplementary Document	Uploaded 2013-02-13	Available
1190-0018_83i Form_100914.pdf	Supplementary Document	Uploaded 2014-10-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
205699	Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form	Form and Instruction	Modified

ICR Details

OMB Control No: 1190-0018	ICR Reference No: 201909-1190-002
Status: Active	Previous ICR Reference No: 201702-1190-001
Agency/Subagency: DOJ/CRT	Agency Tracking No: 1190-0018
Title: Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/09/2019
	Date Received in OIRA: 09/19/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2022	36 Months From Approved	12/31/2019
Responses	210	0	210
Time Burden (Hours)	105	0	105
Cost Burden (Dollars)	0	0	0

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Abstract: Under 8 U.S.C. § 1324b of the Immigration and Nationality Act, the United States Department of Justice, Civil Rights Division, Office of Special Counsel for Immigration-Related Unfair Employment Practices (OSC) requires information on citizenship status, immigration status, national origin, and the nature, timing, and specifics of the alleged discriminatory acts from charging parties alleging discrimination in order to determine jurisdiction over the allegation of employment discrimination and to initiate an investigation based on the allegation.

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Authorizing Statute(s): US Code: 8 USC 13224b Name of Law: Immigration and Nationality Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 24129	04/25/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 42726	06/30/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form	OMB Number 1190-0018, OMB 1190-0018	OSC Charge Form ,   OSC Charge Form

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	210	210	0	0	0	0
Annual Time Burden (Hours)	105	105	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Fewer respondents and lower processing costs.

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Annual Cost to Federal Government: $10,626

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/19/2019

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