Information Collection

DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form

IC 247887 under ICR 202106-1601-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS xxx DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form	Form
DHS xxx CIVIL RIGHTS COMPLAINT DHS Form XXX_Civil Rights Complaint.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	DHS xxx	CIVIL RIGHTS COMPLAINT	DHS Form XXX_Civil Rights Complaint.pdf		Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: DHS ALL-029 Civil Rights and Civil Liberties Records System of Records

FR Citation: 86 FR 33331

Number of Respondents: 692

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	692	692
Annual IC Time Burden (Hours)	692	692
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.