Information Collection

Program Discrimination Complaint Form (State, Local and Tribal Government)

IC 198399 under ICR 202411-0508-001 · OMB 0508-0002.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form AD 3027 Program Discrimination Complaint Form (State, Local and Tribal Government)	Form
AD 3027 USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_EN_Fillable.pdf	Form
AD 3027 USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_EN_Fillable.pdf	Form
AD 3027 Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_ES_Fillable.pdf	Form
AD 3027 Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_ES_Fillable.pdf	Form
AD-3027-v7-July-31 USDA Program Compliant Form AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf	Form and Instruction
AD-3027-v7-July-31 USDA Program Compliant Form AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf	Form and Instruction
AD-3027 ES Fillabl USDA Program Compliant Form AD-3027-v7-July-31-2024-Draft_ES_Fillable_Remediated.pdf	Form and Instruction
AD-3027 ES Fillabl USDA Program Compliant Form AD-3027-v7-July-31-2024-Draft_ES_Fillable_Remediated.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 15.6

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	AD 3027	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_EN_Fillable.pdf	Yes	No	Fillable Printable
Form	AD 3027	Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_ES_Fillable.pdf	Yes	No	Fillable Printable
Form and Instruction	AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediat	USDA Program Compliant Form	AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf	No		Fillable Printable
Form and Instruction	AD-3027 ES Fillable Remediated	USDA Program Compliant Form	AD-3027-v7-July-31-2024-Draft_ES_Fillable_Remediated.pdf	No		Fillable Printable

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: 50

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	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.