Information Collection

Program Discrimination Complaint Form (Individuals)

IC 987 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 FRA Program Discrimination Complaint Form (Individuals)	Form and Instruction
AD 3027 FRA USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_FR_Remediated-FRA.pdf	Form and Instruction
AD 3027 FRA USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_FR_Remediated-FRA.pdf	Form and Instruction
AD 3027 ENG USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf	Form and Instruction
AD 3027 ENG USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf	Form and Instruction
AD 3027 SPA USDA Program Complaint Discrimination Form ad-3027s.pdf	Form and Instruction
AD 3027 SPA USDA Program Complaint Discrimination Form ad-3027s Dec 5 2024.pdf	Form and Instruction
AD 3027 ARA USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_ARA_Fillable_Remediated-ARA.pdf	Form and Instruction
AD 3027 ARA USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_ARA_Fillable_Remediated-ARA.pdf	Form and Instruction
AD 3027 HEB USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_HEB_Fillable_Remediated-HEB.pdf	Form and Instruction
AD 3027 HEB USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_HEB_Fillable_Remediated-HEB.pdf	Form and Instruction
AD 3027 KOR USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_KOR_Fillable_Remediated-KOR.pdf	Form and Instruction
AD 3027 KOR USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_KOR_Fillable_Remediated-KOR.pdf	Form and Instruction
AD 3027 Simplified USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_ZHO_Fillable_Remediated-CHIS.pdf	Form and Instruction
AD 3027 Simplified USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_ZHO_Fillable_Remediated-CHIS.pdf	Form and Instruction
AD 3027 URD USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_URD_Fillable_Remediated-URD.pdf	Form and Instruction
AD 3027 URD USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_URD_Fillable_Remediated-URD.pdf	Form and Instruction
AD 3027 VIE USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_VIE_Fillable_Remediated-VIE.pdf	Form and Instruction
AD 3027 VIE USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_VIE_Fillable_Remediated-VIE.pdf	Form and Instruction
AD 3027 YID USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_YID_Fillable_Remediated-YID.pdf	Form and Instruction
AD 3027 YID USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_YID_Fillable_Remediated-YID.pdf	Form and Instruction
AD 3027TAG USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_TGL_Fillable_Remediated-TAG.pdf	Form and Instruction
AD 3027TAG USDA Program Complaint Discrimination Form AD-3027-v7-July-31-2024-Draft_TGL_Fillable_Remediated-TAG.pdf	Form and Instruction
AD 3027 PUN USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_PAN_Fillable_Remediated-PUN.pdf	Form and Instruction
AD 3027 PUN USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_PAN_Fillable_Remediated-PUN.pdf	Form and Instruction
AD 3027 GER USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_DE_Remediated-GER.pdf	Form and Instruction
AD 3027 GER USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_DE_Remediated-GER.pdf	Form and Instruction
AD 3027 CHIT USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_TC_Remediated-CHIT.pdf	Form and Instruction
AD 3027 CHIT USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_TC_Remediated-CHIT.pdf	Form and Instruction
AD 3027 HTC USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_HT_Remediated-HTC.pdf	Form and Instruction
AD 3027 HTC USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_HT_Remediated-HTC.pdf	Form and Instruction
AD 3027 ITA USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_IT_Remediated-ITA.pdf	Form and Instruction
AD 3027 ITA USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_IT_Remediated-ITA.pdf	Form and Instruction
AD 3027 JAPANESE USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_JA_Remediated-JAP.pdf	Form and Instruction
AD 3027 JAPANESE USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_JA_Remediated-JAP.pdf	Form and Instruction
AD 3027 POL USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_PL_Remediated-POL.pdf	Form and Instruction
AD 3027 POL USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_PL_Remediated-POL.pdf	Form and Instruction
AD 3027 POL USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_PT_Remediated-POR.pdf	Form and Instruction
AD 3027 POL USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_PT_Remediated-POR.pdf	Form and Instruction
AD 3027 RUS USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_RU_Remediated-RUS.pdf	Form and Instruction
AD 3027 RUS USDA Program Discrimination Complaint Form AD-3027-v7-July-31-2024-Draft_RU_Remediated-RUS.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Program Discrimination Complaint Form (Individuals)

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

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 and Instruction	AD 3027 FRA	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_FR_Remediated-FRA.pdf	Yes	No	Fillable Printable
Form and Instruction	AD 3027 ENG	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf	Yes	No	Fillable Printable
Form and Instruction	AD 3027 SPA	USDA Program Complaint Discrimination Form	ad-3027s Dec 5 2024.pdf	No		Fillable Printable
Form and Instruction	AD 3027 ARA	USDA Program Complaint Discrimination Form	AD-3027-v7-July-31-2024-Draft_ARA_Fillable_Remediated-ARA.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 HEB	USDA Program Complaint Discrimination Form	AD-3027-v7-July-31-2024-Draft_HEB_Fillable_Remediated-HEB.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 KOR	USDA Program Complaint Discrimination Form	AD-3027-v7-July-31-2024-Draft_KOR_Fillable_Remediated-KOR.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 Simplified Chinese	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_ZHO_Fillable_Remediated-CHIS.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 URD	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_URD_Fillable_Remediated-URD.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 VIE	USDA Program Complaint Discrimination Form	AD-3027-v7-July-31-2024-Draft_VIE_Fillable_Remediated-VIE.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 YID	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_YID_Fillable_Remediated-YID.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027TAG	USDA Program Complaint Discrimination Form	AD-3027-v7-July-31-2024-Draft_TGL_Fillable_Remediated-TAG.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 PUN	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_PAN_Fillable_Remediated-PUN.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 GER	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_DE_Remediated-GER.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 CHIT	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_TC_Remediated-CHIT.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 HTC	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_HT_Remediated-HTC.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 ITA	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_IT_Remediated-ITA.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 JAPANESE	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_JA_Remediated-JAP.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 POL	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_PL_Remediated-POL.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 POL	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_PT_Remediated-POR.pdf	Yes	Yes	Fillable Printable
Form and Instruction	AD 3027 RUS	USDA Program Discrimination Complaint Form	AD-3027-v7-July-31-2024-Draft_RU_Remediated-RUS.pdf	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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: 158

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	Previously Approved
Annual Number of Responses for this IC	158	158
Annual IC Time Burden (Hours)	158	158
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.