DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form

Forms and Documents

Document Name	Status
Form DHS xxx DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form Form	New
Supporting Statement A (CRCL Compliance) 8 2021.docx Supporting Statement A	2021-08-23
2021-13210 (1).pdf Supplementary Document	2021-08-23
USC 42 2000ee-1.pdf Supplementary Document	2021-08-23
USC 6 345.pdf Supplementary Document	2021-08-23
2021-17959.pdf Supplementary Document	2021-08-23
2021-13210.pdf Supplementary Document	2021-07-01

IC Document Collections

IC ID	Document Title	Status
247887	DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form Form	New

ICR Details

OMB Control No:	ICR Reference No: 202106-1601-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DHS/OS	Agency Tracking No:
Title: DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/23/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	692	0
Time Burden (Hours)	692	0
Cost Burden (Dollars)	0	0

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Abstract: The U.S. Department of Homeland Security (DHS), Office for Civil Rights and Civil Liberties (CRCL) reviews and investigates civil rights and civil liberties complaints filed by the public regarding U.S. Department of Homeland Security (DHS) policies and activities. Under 6 U.S.C. 345 and 42 U.S.C. 2000ee-1, CRCL reviews and assesses allegations involving a range of alleged civil rights and civil liberties abuses, such as: • Discrimination based on race, ethnicity, national origin, religion, sex, sexual orientation, gender identity, or disability; • Violation of rights while in immigration detention or as subject of immigration enforcement; • Discrimination or inappropriate questioning related to entry into the United States; • Violation of due process rights, such as the right to timely notice of charges or access to lawyer; • Violation of confidentiality provisions of the Violence Against Women Act; • Physical abuse or any other type of abuse; • Denial of meaningful access to DHS or DHS-supported programs, activities, or services due to limited English proficiency and • Any other civil rights, civil liberties, or human rights violation related to a Department program or activity, including allegations of discrimination by an organization or program that receives financial assistance from DHS.

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Authorizing Statute(s): US Code: 6 USC 345 Name of Law: Establishment of Officer for Civil Rights and Civil Liberties
   US Code: 42 USC 2000ee-1 Name of Law: Privacy and civil liberties officers
  

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:
	86 FR 33331	06/24/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 47133	08/23/2021
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
DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form	DHS xxx	CIVIL RIGHTS COMPLAINT

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ICR Summary of Burden

	Total Request	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	692	0	0	692	0	0
Annual Time Burden (Hours)	692	0	0	692	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

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Annual Cost to Federal Government: $197,460

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? No

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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: 08/23/2021

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