Information Collection

DHS Individual Complaint of Employment Discrimination

IC 20218 under ICR 202103-1610-001 · OMB 1610-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1610-0001 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS Form 3090-1 DHS Individual Complaint of Employment Discrimination	Form and Instruction
DHS Form 3090-1 DHS Individual Compliant of Employment Discrimination DHS Form 3090-1.pdf	Form and Instruction

IC Title:

DHS Individual Complaint of Employment Discrimination

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 1614

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
Form and Instruction	DHS Form 3090-1	DHS Individual Compliant of Employment Discrimination	DHS Form 3090-1.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 136

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	136	-1,064	1,200
Annual IC Time Burden (Hours)	68	-532	600
Annual IC Cost Burden (Dollars)	0	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.