EEO Complaint Forms

ICR 202208-1505-002

OMB: 1505-0262

Federal Form Document

ICR Details
1505-0262 202208-1505-002
Received in OIRA 202207-1505-002
EEO Complaint Forms
No material or nonsubstantive change to a currently approved collection   No
Regular 08/11/2022
  Requested Previously Approved
06/30/2025 06/30/2025
90 90
47 47
0 0

Treasury employees, former employees, and applicants for employment may contact the Department’s EEO Offices if they believe they have been subjected to discrimination based on race, color, sex (includes sexual harassment, sexual orientation and gender identity), national origin, religion, disability, age (40 or over), parental status, protected genetic information, or retaliation. A Treasury staff member responsible for obtaining information regarding the claim(s) of discrimination will record on a Report of Counseling (Intake) Form the aggrieved party’s (“the aggrieved”) personal information, i.e., name, address, telephone numbers, etc., as well as the bases and issues raised by the aggrieved. Thereafter, an EEO Counselor will be assigned, who will review the information on the Report of Counseling (Intake) Form and contact the aggrieved to schedule an initial interview. This interview may include, but is not limited to: verifying the information on the Intake Form, clearly defining the scope of the issues, reviewing the rights and responsibilities of the aggrieved and the agency during the EEO complaint process including the right to representation and anonymity, the applicable time frames, the option to extend the counseling process, the right to choose between Alternative Dispute Resolution (ADR) and EEO Counseling, and the overall stages of the complaint process.


Not associated with rulemaking

  87 FR 3384 01/21/2022
87 FR 18073 03/29/2022

  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 90 90 0 0 0 0
Annual Time Burden (Hours) 47 47 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0

Clarissa Lara 202 257-2981


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:
    (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;
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.

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