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Individuals or Households
Workplace Discrimination Complaints
OMB: 3060-1237
IC ID: 226756
OMB.report
FCC
OMB 3060-1237
ICR 202305-3060-014
IC 226756
( )
Documents and Forms
Document Name
Document Type
Form FCC Form 5622
Individuals or Households
Form
FCC Form 5622 FORMAL COMPLAINT OF DISCRIMINATION
FCC FORMAL COMPLAINT FORM.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Individuals or Households
Agency IC Tracking Number:
OWD
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
29 CFR 1614.105
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
FCC Form 5622
FORMAL COMPLAINT OF DISCRIMINATION
FCC FORMAL COMPLAINT FORM.pdf
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
General Government
Subfunction:
Central Fiscal Operations
Privacy Act System of Records
Title:
EEOC/GOVT-1, Equal Opportunity in the Federal Government
FR Citation:
81 FR 81116
Number of Respondents:
8
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
8
0
0
-3
0
11
Annual IC Time Burden (Hours)
26
0
0
-7
0
33
Annual IC Cost Burden (Dollars)
6,000
0
0
2,000
0
4,000
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.
