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DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form
DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form
OMB: 1601-0035
IC ID: 247887
OMB.report
DHS/OS
OMB 1601-0035
ICR 202212-1601-001
IC 247887
( )
Documents and Forms
Document Name
Document Type
DHS_CRCL_Civil Rights Complaint Form_8-1-22.pdf
www.dhs.gov/file-civil-rights-complaint
Other-website
DHS_CRCL_Civil Rights Complaint Form_8-1-22.pdf
www.dhs.gov/file-civil-rights-complaint
Other-website
PRA Screenshots for Web Portal.docx
Other-screenshots
PRA Screenshots for Web Portal.docx
Other-screenshots
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-website
DHS_CRCL_Civil Rights Complaint Form_8-1-22.pdf
https://www.dhs.gov/file-civil-rights-complaint
Yes
No
Fillable Printable
Other-screenshots
PRA Screenshots for Web Portal.docx
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Labor Rights Management
Privacy Act System of Records
Title:
DHS ALL-029 Civil Rights and Civil Liberties Records System of Records
FR Citation:
86 FR 33331
Number of Respondents:
2,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
50 %
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
2,000
0
0
0
0
2,000
Annual IC Time Burden (Hours)
2,000
0
0
0
0
2,000
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.