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Program Discrimination Complaint Form (Individuals)
USDA Program Discrimination Complaint Form
OMB: 0508-0002
IC ID: 987
OMB.report
USDA/AgOCR
OMB 0508-0002
ICR 202210-0508-001
IC 987
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0508-0002 can be found here:
2024-08-29 - Reinstatement without change of a previously approved collection
2022-12-07 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Program Discrimination Complaint Form (Individuals)
Form
USDA Program Discrimination Complaint Form
AD3027 Program Discrimination Complaint From (proposed form) 10.04.22.pdf
Form
USDA Program Discrimination Complaint Form
AD3027 Program Discrimination Complaint From (proposed form) 10.04.22.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Program Discrimination Complaint Form (Individuals)
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
7 CFR 15.6
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
N/A
USDA Program Discrimination Complaint Form
AD3027 Program Discrimination Complaint From (proposed form) 10.04.22.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
USDA/OASCR-1, Civil Rights Enterprise System, (CRES)
FR Citation:
83 FR 65135
Number of Respondents:
158
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
158
0
0
0
0
158
Annual IC Time Burden (Hours)
158
0
0
0
0
158
Annual IC Cost Burden (Dollars)
0
0
0
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.