Information Collection

Unfair Immigration-Related Employment Practices Complaint Form

IC 217474 under ICR 202109-1125-006 · OMB 1125-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1125-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form EOIR-58 Unfair Immigration-Related Employment Practices Complaint Form	Form and Instruction
EOIR-58 Unfair Immigration-Related Employment Practices Complain 274B Complaint Form - Dec. 2021 Final.pdf	Form and Instruction

IC Title:

Unfair Immigration-Related Employment Practices Complaint Form

Agency IC Tracking Number:

EOIR-58

Is this a Common Form? No

IC Status: Modified

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 and Instruction	EOIR-58	Unfair Immigration-Related Employment Practices Complaint Form	274B Complaint Form - Dec. 2021 Final.pdf		Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Investigation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 26

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	26	4	22
Annual IC Time Burden (Hours)	26	4	22
Annual IC Cost Burden (Dollars)	260	-1,176	1,436

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.