Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice

Forms and Documents

Document Name	Status
Form OMB Number 1190-00 Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice Form and Instruction	Unchanged
1190-0008 OMB 83-I_113016.pdf Supplementary Document	2016-11-30
1190-0008_Law_Title VI regulations.pdf Supplementary Document	2014-04-09
1190-0008_Law_Title VI.pdf Supplementary Document	2014-04-09
.1190-0008_Supporting_Statement_113016.doc Supporting Statement A	2016-11-30

IC Document Collections

IC ID	Document Title	Status
12903	Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice Form and Instruction	Unchanged

ICR Details

OMB Control No: 1190-0008	ICR Reference No: 202002-1190-001
Status: Active	Previous ICR Reference No: 201611-1190-003
Agency/Subagency: DOJ/CRT	Agency Tracking No: 1190-0008
Title: Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice
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: 05/07/2020
	Date Received in OIRA: 02/25/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2023	36 Months From Approved	05/31/2020
Responses	4,000	0	4,000
Time Burden (Hours)	2,000	0	2,000
Cost Burden (Dollars)	0	0	0

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Abstract: Information is used to find jurisdiction to investigate the alleged discrimination, to seek whether a referral to another agency is necessary, and to provide information needed to initiate investigation of the complaint. Respondents are individuals.

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Authorizing Statute(s): US Code: 42 USC 2000d et seq. Name of Law: Title VI of the Civil Rights Act, 1964
   US Code: 28 USC 42.101 rt seq. Name of Law: Antidiscrimination provision of the Omnibus Crime Control and Safe Streets 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:
	84 FR 66934	12/16/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 10476	02/24/2020
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Complaint Form, Federal Coordination and Compliance Section, Civil Rights Division, U.S. Department of Justice	None, OMB Number 1190-0008, OMB Number 1190-0008, OMB Number 1190-0008, OMB Number 1190-0008	FCS Complaint Consent Korean ,   FCS Complain Consent Vietnamese ,   FCS Complaint Consent Spanish ,   FCS Complaint Consent Chinese ,   FCS Complaint and Consent Form

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ICR Summary 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	4,000	4,000	0	0	0	0
Annual Time Burden (Hours)	2,000	2,000	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:

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Annual Cost to Federal Government: $14,080

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: 02/25/2020

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