FCC Anti-Harassment Intake Form

ICR 202002-3060-026

OMB: 3060-1267

Federal Form Document

Forms and Documents
IC Document Collections
238054 Unchanged
ICR Details
3060-1267 202002-3060-026
Active 201910-3060-011
FCC Anti-Harassment Intake Form
No material or nonsubstantive change to a currently approved collection   No
Approved without change 02/26/2020
Retrieve Notice of Action (NOA) 02/25/2020
  Inventory as of this Action Requested Previously Approved
12/31/2022 12/31/2022 12/31/2022
5 0 5
18 0 18
4,050 0 4,050

The Commission is submitting a non-substantive change request to an existing information collection pursuant to 44 U.S.C. § 3507. The only change in the supporting statement is the substitution of the appropriate SORN which was previously approved by the Office of Management and Budget (OMB) on December 20, 2019. The record retention and similar provisions under the government-wide SORN are not significantly different from those previously reviewed and approved. Therefore, the supporting statement has been corrected to support this non-substantive change request to OMB. Also, there are no changes in the burdens and the costs remain the same for this information collection. This information, completed on FCC Form 5632, will be used by OWD and HRM to process, track, and maintain the confidentiality of Anti-Harassment Intake Form requests.

US Code: 42 USC 2000e Name of Law: Age Discrimination in Employment Act of 1967 (ADEA)
   US Code: 29 USC 621-634 Name of Law: Americans with Disabilities Act of 1990 (ADA), as amended
   US Code: 42 USC 12101-12213 Name of Law: Rehabilitation Act of 1973
   US Code: 7 USC 7 Name of Law: Civil Rights Act of 1964, as amended
   US Code: 29 USC 501 Name of Law: Americans with Disabilities Act of 1990 (ADA), as amended

Not associated with rulemaking

  84 FR 37871 08/02/2019
84 FR 54144 10/09/2019

IC Title Form No. Form Name
FCC Anti-Harassment Intake Form FCC Form 5632 FCC Anti-Harassment Intake Form

  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 5 5 0 0 0 0
Annual Time Burden (Hours) 18 18 0 0 0 0
Annual Cost Burden (Dollars) 4,050 4,050 0 0 0 0
This is a new information collection request resulting in a program change/increase to the total claimants of 5, total annual responses of 5 and total annual burden hours of 18 hours. These estimates will be added to OMB’s Active Inventory.

Cynthia Bryant 202 418-8165 [email protected]


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:
    (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;
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.

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