Information Collection

Civil Rights Discrimination Complaint

IC 28940 under ICR 202209-2900-012 · OMB 2900-0662.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0662 can be found here:

Documents and Forms

Document Name Document Type
Form 10-0381 Civil Rights Discrimination Complaint Form
10-0381 Civil Rights Discrimination Complaint 10-0381-fill_20140319.pdf Form
10-0381 Civil Rights Discrimination Complaint 10-0381-fill_20140319.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Civil Rights Discrimination Complaint	Agency IC Tracking Number:	2900-0662

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 15 38 CFR 18.501 38 CFR 18.401 45 CFR 90 38 CFR 18.1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-0381	Civil Rights Discrimination Complaint	10-0381-fill_20140319.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Litigant, Tort Claimant, EEO Complainant and Third Party Recovery Files-VA	FR Citation: 47 FR 8

Number of Respondents: 450	Number of Respondents for Small Entity: 1

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	450	267	183
Annual IC Time Burden (Hours)	113	67	46
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.