Information Collection

Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)

IC 4809 under ICR 202403-0690-001 · OMB 0690-0015.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CD498 Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)	Form
CD498 COMPLAINT OF EMPLOYMENT DISCRIMINATION Revised Form CD498 (March 2024).pdf	Form
CD498 COMPLAINT OF EMPLOYMENT DISCRIMINATION Revised Form CD498 (March 2024).pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CD498	COMPLAINT OF EMPLOYMENT DISCRIMINATION	Revised Form CD498 (March 2024).pdf		No		Paper Only

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 160

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	160	-40	200
Annual IC Time Burden (Hours)	80	-20	100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.