Information Collection

Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor

IC 13803 under ICR 201910-1250-003 · OMB 1250-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1250-0002 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
cc 4 instructions.docx webapps.dol.gov/ofccp-claims/help/english.html	Instruction
CC-4 Complaint Involving Employment Discrimination by a Feder ComplaintForm.docx webapps.dol.gov/ofccp-claims/english.html	Form

IC Title:

Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 41 CFR 60-741.61 41 CFR 60-1.23 41 CFR 60-300.61 (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Instruction			cc 4 instructions.docx	https://webapps.dol.gov/ofccp-claims/help/english.html	Yes	Yes	Fillable Fileable
Form	CC-4	Complaint Involving Employment Discrimination by a Federal Contractor or Subcontractor	ComplaintForm.docx	https://webapps.dol.gov/ofccp-claims/english.html	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: Complaint Case Files, DOL/ESA-2

FR Citation: 67 FR 16868

Number of Respondents: 897

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	897	144	753
Annual IC Time Burden (Hours)	897	144	753
Annual IC Cost Burden (Dollars)	169	107	62

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.