U.S. Department of Agriculture
Supporting Statement
USDA Program Complaint Discrimination Form
OMB Number: 0508-0002
The agency plans to comply with the current Terms of Clearance.
Explain the circumstances that make the collection of information necessary. Identify any legal or administrative requirements that necessitate the collection. Attach a copy of the appropriate section of each statute and regulation mandating or authorizing the collection of information.
This is a reinstatement of a previously approved collection with change, for which approval has expired. In compliance with Section 515 of the Treasury and General Government Appropriations Act of 2001, the Office of the Assistant Secretary for Civil Rights (OASCR) must submit an ICR Package to renew OMB Form Number 0508-0002, USDA’s Program Complaint Form. Under 7 CFR 15.6 “any person who believes himself or any specific class of individuals to be subjected to discrimination…may by himself or by an authorized representative file a written complaint based on the ground of such discrimination.” The form is used to collect data to process Title VI complaints. The collection of this information is the avenue by which the individuals or their representatives may file such a complaint. The requested information is necessary for the USDA’s Office of the Assistant Secretary for Civil Rights (OASCR) to address the alleged discriminatory action.
Indicate how, by whom, how frequently, and for what purpose the information is to be used. Except for a new collection, indicate the actual use the agency has made of the information received from the current collection.
The requested information, which can be submitted by completing a form Agriculture Department (AD) 3027 or by submitting a letter, is necessary in order for OASCR to address the alleged discriminatory action. The respondent is asked to state his/her name, mailing address, property address (if different from mailing address), telephone number, email address (if any) and to provide a name and contact information for the respondent’s representative (if any.)
A brief description of who was involved with the alleged discriminatory action, what occurred and when, is requested. If the respondent is filing the program discrimination complaint within 180 days after the alleged discrimination occurred, the respondent is asked to provide the reason for the delay.
The respondent is asked to identify which bases are alleged to have motivated the discriminatory action (of those bases prohibited under either 7 C.F.R. 15d.2: race, color, national origin, age, sex, disability, religion, sexual orientation, marital or familial status, or because all or part of the individual’s income is derived from any public assistance program; or under nondiscrimination regulations applying to recipients of Federal financial assistance from USDA: race, color, national origin, sex, age, disability, religion or political beliefs.) (Not all bases apply to all programs.)
Finally, the respondent is asked to provide information about what would be required to resolve the complaint, from his or her perspective, as well as information about whether the respondent has previously filed a complaint about the incident in another forum.
OASCR uses the form information provided by the respondent to evaluate, investigate, and, as appropriate, attempt resolution and settle the case. The data collection instrument is available in a specific format that is provided to the public to assist in gathering the necessary information to open a program discrimination complaint case in a manner most efficient and least intrusive for the public/customer.
Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g., permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also, describe any consideration of using information technology to reduce burden.
USDA/OASCR makes every effort to comply with the E-Government Act, 2002 (E-Gov) and to provide for alternative submission of information collections. This form can also be downloaded from the USDA website, completed and submitted by email or United States mail. The agency does not currently have an electronic web-based database to allow respondents to submit AD 3027 to USDA.
Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purpose described in item 2 above.
There is no similar data collection available. Every effort has been made to avoid duplication. The agency has reviewed USDA reporting requirements, state administrative agency reporting requirements, and special studies by other government and private agencies. OASCR solely monitors race & ethnicity complaints to ensure integrity. The information required for data collection is currently reported to all other sub-agencies on a regular basis in a standardized form and then complied at the Department level for reporting.
If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.
Approximately 20 small businesses or entities will use this form each year. The submission of information regarding alleged discrimination is of a minimum burden and is of the same intensity for any member of the public/customer who wishes to submit a complaint.
Describe the consequence to Federal program or policy activities if the collection is not conducted or is conducted less frequently, as well as any technical or legal obstacles to reducing burden.
This information collection is a mandatory and a one-time data collection given the alleged discrimination event. If the agency does not conduct this data collection request, it would not be in compliance with 7 CFR 15.6. If information regarding alleged discrimination is not collected from the individual who believes he/she has experienced discrimination in a USDA program, it would be impossible for USDA to address and rectify the alleged discrimination.
7. Explain any special circumstances that would cause an information collection to be conducted in a manner:
requiring respondents to report information to the agency more often than quarterly.
requiring respondents to prepare a written response to a collection of information in fewer than 30 days after receipt of it.
requiring respondents to submit more than an original and two copies of any document.
requiring respondents to retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years.
in connection with a statistical survey, that is not designed to produce valid and reliable results that can be generalized to the universe of study.
requiring the use of a statistical data classification that has not been reviewed and approved by OMB.
that includes a pledge of confidentiality that is not supported by authority established in statute or regulation, that is not supported by disclosure and data security policies that are consistent with the pledge, or which unnecessarily impedes sharing of data with other agencies for compatible confidential use; or
requiring respondents to submit proprietary trade secret, or other confidential information unless the agency can demonstrate that it has instituted procedures to protect the information's confidentiality to the extent permitted by law.
There are no special circumstances. The collection is conducted in a manner consistent with guidelines in 5 CFR 1320.5.
If applicable, provide a copy and identify the date and page number of the publication in the Federal Register of the agency's notice, soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the agency in response to these comments.
Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, the clarity of instructions and recordkeeping, disclosure, or reporting form, and on the data elements to be recorded, disclosed, or reported.
Federal Register Notice: A Federal Register Notice requesting public comments on this information collection published May 14, 2024—FRDOC. Volume 89 FR 41927 Page: 41927-41928 document number 2024-1053
No public comment(s) was received in response to the 60-day Federal Register Notice.
Consultation with persons outside the agency: OASCR consulted with individuals outside USDA regarding frequency, burden, cost and use of OMB No. 0508-0002. As a result of the consults, there were no concerns with burden, or frequency in use of the form. The following individuals provided input on the form and are available for contact by OMB given their input:
James Nesbit [email protected]
As a result of the examination of the form, there were no concerns with burden, or frequency and use of the form (10-20 min to complete the form).
Kaneisha Miller [email protected]
As a result of the examination consults, there were no concerns with burden, or frequency in use of the form (20 min and 59 seconds to complete the form).
Jyles Zellner [email protected]
As a result of the from examination there were no concerns with burden, or frequency in use of the form (30 min to complete the form).
Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.
No payment to or gift will be provided to individuals in return for responding.
Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.
The information provided on this form will only be shared with persons who have an official need to know and will be protected from public disclosure pursuant to the provisions of the Privacy Act, 5 U.S.C. § 552a(b) (Privacy Act). Site public information of the SORN In accordance with the Privacy Act OASCR maintains a system of records which contains complaints alleging discrimination in USDA program and Equal Employment Opportunities (EEO) programs and activities. In FY 2021, the Civil Rights Enterprise System was modified to address updates to the system location, categories of records, routine uses, one of which permits records to be provided to the National Achieves and Records Administration, storage, safeguards, retention and disposal, system manager and address, notification procedures, records access and contesting procedures. The modification to the SORN was published on August 17, 2021, Federal Registrar Vol 86 No 156.
Provide additional justification for any questions of a sensitive nature, such as sexual behavior or attitudes, religious beliefs, and other matters that are commonly considered private. This justification should include the reasons why the agency considers the questions necessary, the specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.
Under 7 C.F.R 15.6, “Any person who believes himself/herself or any specific class of individuals to be subjected to discrimination [in any USDA assisted program or activity] … may by himself/herself or by an authorized representative file… a written complaint.” Under 7 C.F.R. 15d.4, “Any person who believes that he or she (or any specific class of individuals) has been, or is being, subjected to [discrimination in any USDA conducted program or activity] … may file on his or her own, or through an authorized representative, a written complaint alleging such discrimination.” The collection of this information is an avenue by which the individual or his representative may file such a program discrimination complaint.
The requested information, which can be submitted by filling out a form or by submitting written correspondence, is necessary for the USDA OASCR to address the alleged discriminatory action. The respondent is asked to state his/her name, mailing address, property address (if different from mailing address), telephone number, email address (if any) and to provide a name and contact information for the respondent’s representative (if any.)
A brief description is requested of who was involved with the alleged discriminatory action, what and when it occurred. If the respondent is filing the program discrimination complaint more than 180 days after the alleged discrimination occurred, the respondent is asked to provide the reason for the delay.
The respondent is asked to identify which bases are alleged to have motivated the discriminatory action (of those bases prohibited under either 7 C.F.R. 15d.2: race, color, national origin, age, sex, disability, religion, sexual orientation, marital or familial status, or because all or part of the individual’s income is derived from any public assistance program; or under nondiscrimination regulations applying to recipients of Federal financial assistance from USDA: race, color, national origin, sex, age, disability, religion or political beliefs.) (Not all bases apply to all programs).
Finally, the respondent is asked to provide information about what would be required to resolve the complaint, from his or her perspective, as well as information about whether the respondent has previously filed a complaint about the incident in another forum.
The program discrimination complaint filing information, which is voluntarily provided by the respondent, will be used by the staff of USDA OASCR to intake, investigate, and adjudicate the respondent’s complaint. The program discrimination complaint form will enable OASCR to better collect information from complainants in a timely manner, therefore reducing delays and errors in determining USDA jurisdiction.
In addition, the respondent is asked voluntarily to provide his or her race, ethnicity, gender, and national origin. This information will be used to help USDA monitor enforcement of laws that require equal access to its programs for eligible persons.
Provide estimates of the hour burden of the collection of information. The statement should:
The source of the hourly wage rates were obtained from the U.S. Department of Labor, Bureau of Labor Statistics, May 2023 National Industry-Specific Occupational Employment and Wage Estimates (https://www.bls.gov/oes/current/oessrci.htm). There is no recordkeeping or third-party disclosure.” The number of respondents per year is 280. The respondents will submit one complaint per which equals a total of 280 annual responses. The time required to complete the form is sixty minutes or 1 hour per responses for a estimated 280 total annual burden hours.
The cost burden for the respondent at an average hourly wage of $45.52 (which includes fringe benefit cost) multiplied by the average number of program complaint forms received by the user population would total $12,718.
Provide estimates of the total annual cost burden to respondents or record keepers resulting from the collection of information, (do not include the cost of any hour burden shown in items 12 and 14). The cost estimates should be split into two components: (a) a total capital and start-up cost component annualized over its expected useful life; and (b) a total operation and maintenance and purchase of services component.
There are no capital or startup costs, nor operation/maintenance costs for respondents.
14. Provide estimates of annualized costs to the Federal government. Also, provide a description of the method used to estimate costs and any other expense that would not have been incurred without this collection of information.
The cost to the federal government for the intake of this information is $4,284. The estimated cost to process each form assumes that the data from one contact will take 30 minutes to process by a federal employee at a FY 2020 GS-7 Step 5 salary. The Office of Personnel Management states that this salary is $30.37/hr. (fringe benefit cost is included). The cost to process the application is approximately $15.30 per form.
15. Explain the reasons for any program changes or adjustments reported in Items 13 or 14 of the OMB Form 83-1.
This is a reinstatement with change of a previously approved collection for which approval has expired. There is a change in the number of respondents estimated in 2021. The agency is requesting an estimated 280 total annual burden hours. The number of total annual respondents cited in this supporting statement shows an increase by 2 from 278 respondents in 2022 to a projected 280 respondents. The methodology includes an average of program complaint participants over the three-year period from 2020, 2021 and 2022. This increase in respondents and is a modification that is not the result of deliberate federal government action uncontrollable not due to no direct action from the Federal government action.
16. For collections of information whose results are planned to be published, outline plans for tabulation and publication.
The agency plans to display the expiration date for OMB approval of the information collection.
17. If seeking approval to not display the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.
The agency is seeking approval to display the OMB expiration date on the form associated with this information collection. If an expiration number is displayed on the questionnaire that will be used as the data collection instrument, when the expiration date is past, the form will be out of date and will require retiring and destroying forms that have the past expiration date.
18. Explain each exception to the certification statement identified in Item 19 "Certification for Paperwork Reduction Act."
The request is in full compliance with the identified certification statement.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Brooks |
| File Modified | 0000-00-00 |
| File Created | 2024-09-04 |