Information Collection

General Complaint form

IC 251368 under ICR 202206-0581-002 · OMB 0581-0333.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PSD-5001 General Complaint form	Form and Instruction
PSD-5001 complaint form AMS USDA DOJ Form Page.pdf	Form and Instruction
PSD-5001 complaint form AMS USDA DOJ Form Page.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

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	PSD-5001	complaint form	AMS USDA DOJ Form Page.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 110

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	110	55	55
Annual IC Time Burden (Hours)	165	82	83
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.