OFCCP OMBuds Referral Form

DOL – OFCCP

Ombuds Service Referral Form

OMB Control No. 1225-0088

Request for Approval under the “DOL Departmental Generic Clearance for the Collection of Routine Customer Feedback”

(OMB Control Number: 1225-0088)

TITLE OF INFORMATION COLLECTION

OFCCP Ombuds Referral Form

PURPOSE

The U.S. Department of Labor’s (DOL) Office of Federal Contract Compliance Programs (OFCCP) administers and enforces three equal employment opportunity laws: Executive Order 11246, as amended; Section 503 of the Rehabilitation Act of 1973, as amended (Section 503); and the Vietnam Era Veterans’ Readjustment Assistance Act of 1974, as amended. These laws prohibit covered federal contractors and subcontractors (hereafter collectively referred to as “contractors”) from discriminating based on race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. Additionally, contractors are prohibited from taking adverse employment actions against applicants and employees for asking about, discussing, or sharing information about their pay or the pay of their co-workers, subject to certain limitations.

OFCCP runs an Ombuds Service, which works with a variety of stakeholders nationwide, including contractors, contractor representatives, industry groups, law firms, complainants, worker rights organizations, and current and potential employees of federal contractors. The Ombuds provides assurance to contractors and other stakeholders that OFCCP is treating them fairly. OFCCP seeks approval for an Ombuds referral form. Stakeholders use the Ombuds referral form to contact the Ombuds about matters they want assistance with (e.g., assistance with case or complaint resolutions).

DESCRIPTION OF RESPONDENTS

Respondents will be federal contractors, their employees, or their representatives.

TYPE OF COLLECTION (Check one)

[X] Customer Comment Card/Complaint Form [ ] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name

Tina Williams

Acting Deputy Director of OFCCP and Director of Policy & Program Development

Office of Federal Contract Compliance Programs

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [X] Yes [ ] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ X ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [ ] No [X] N/A

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

OFCCP estimates 10 annual referral form submissions. OFCCP estimates that it will take each respondent 10 minutes to complete the form. The total annual time burden is 1.67 hours (10 respondents x 10 minutes/60 = 1.67 hours).

Category of Respondent	No. of Respondents	Participation Time (in minutes)	Estimated Burden (in hours)
Private Sector	10	10 minutes	1.67 hours
Totals	10	10 minutes	1.67 hours

FEDERAL COST

The estimated annual cost to the Federal government is $70.50. This estimate is based on staff taking 5 minutes to analyze each response ([$84.55¹ x 5 minutes/60] x 10 responses = $70.50).

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [X ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[X] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [X] Yes [ ] No

1 The hourly rate is based on GS-15, Step 5 pay. See “Salary Table 2023-DCB Incorporating the 4.1% General Schedule Increase and a Locality Payment of 32.49% For the Locality Pay Area of Washington-Baltimore-Arlington, DC-MD-VA-WV-PA",” available at https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2023/DCB_h.pdf (last accessed Nov. 2023).

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