Information Collection

Discrimination Complaints

IC 183761 under ICR 202101-1225-002 · OMB 1225-0077.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0077 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Sample Discrimination Complaint Form.docx	Other-Sample Complaint Form
Sample Discrimination Complaint Form.docx	Other-Sample Complaint Form
Discrimination Complaint Log Instructions.docx	Instruction
Discrimination Complaint Log Instructions.docx	Instruction
DL-1-2014A Complaint Information Form DL1-2014a-English.pdf www.dol.gov/sites/dolgov/files/OASAM/legacy/files/DL1-2014a-English.pdf	Form and Instruction
DL-1-2014A Complaint Information Form DL1-2014a-English.pdf www.dol.gov/sites/dolgov/files/OASAM/legacy/files/DL1-2014a-English.pdf	Form and Instruction

IC Title:

Discrimination Complaints

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 38.70 29 CFR 37.74 29 CFR 38.73 29 CFR 37.73(a)-(d) 29 CFR 38.72 29 CFR 38.74 29 CFR 38.80

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
Other-Sample Complaint Form			Sample Discrimination Complaint Form.docx		Yes	No	Paper Only
Instruction			Discrimination Complaint Log Instructions.docx		Yes	Yes	Fillable Fileable
Form and Instruction	DL-1-2014A	Complaint Information Form	DL1-2014a-English.pdf	https://www.dol.gov/sites/dolgov/files/OASAM/legacy/files/DL1-2014a-English.pdf	Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: DOL/OASAM-22

FR Citation: 83 FR 25766

Number of Respondents: 35,099

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 15 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	35,099	35,099
Annual IC Time Burden (Hours)	35,099	35,099
Annual IC Cost Burden (Dollars)	0	0

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.