NRC Form 646, "Formal Discrimination Complaint"

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form NRC Form 646 Formal Discrimination Complaint	Form and Instruction	Modified	Available
Form NRC Form 646 NRC Form 646, "Formal Discrimination Complaint"	Form and Instruction	Modified	Repair queued
Nonsubstantive change request NRC Form 646.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-06	Available
Nonsubstantive change request NRC Form 646.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-06	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
253906	NRC Form 646, "Formal Discrimination Complaint"	Form and Instruction	Modified	Formal Discrimination Complaint
253906	NRC Form 646, "Formal Discrimination Complaint"	Form and Instruction	Modified

ICR Details

OMB Control No: 3150-0255	ICR Reference No: 202503-3150-001
Status: Active	Previous ICR Reference No: 202205-3150-001
Agency/Subagency: NRC	Agency Tracking No:
Title: NRC Form 646, "Formal Discrimination Complaint"
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/21/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/20/2025
Terms of Clearance: In accordance with 5 CFR 1320, this information collection is approved. This change is consistent with Execution Order 14168, "Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government."

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2026	01/31/2026	01/31/2026
Responses	30	0	30
Time Burden (Hours)	30	0	30
Cost Burden (Dollars)	0	0	0

---

Abstract: As set forth under 29 CFR 1614, the EEO complaint process prescribes that when an aggrieved individual believes that they have been discriminated against on the basis of their race, color, religion, sex (including sexual orientation, gender identity and expressions, and pregnancy), national origin, age, disability, genetic information (including family medical history), marital status, parental status, political affiliation, military service, and reprisal and seeks EEO counseling, the assigned EEO Counselor will conduct the pre-complaint (Informal) with the intentions of resolving the complaint within the Agency. At the conclusion of pre-complaint (Informal) process and if resolution was unsuccessful, the EEO Counselor during the final interview with the aggrieved person must discuss what occurred during the counseling process and provide the aggrieved with information to move the matter forward. Pursuant to 29 CFR § 1614.105(c), if the aggrieved individual decides to file a Formal complaint (i.e., NRC Form 646), the EEO Counselor must submit a written report (i.e., EEO Counselors Report) within fifteen (15) calendar days to the SBCR Director or designated official that will contain relevant information about the aggrieved individual, jurisdiction, claims, bases, Responding Management Officials (RMO), witnesses, requested remedies, and the EEO Counselor's checklist. Once received by the NRC, an authorized NRC representative will place the completed NRC Form 646 in a secure folder created specifically for the aggrieved individual within an automated tracking system.

---

Authorizing Statute(s): PL: Pub.L. 88 - 352 703 Name of Law: Title VII of the Civil Rights Act of 1964, as amended
   PL: Pub.L. 93 - 112 501 Name of Law: Rehabilitation Act of 1973
   PL: Pub.L. 90 - 202 621 Name of Law: Age Discrimination in Employment Act of 1967
   PL: Pub.L. 88 - 38 206 Name of Law: Equal Pay Act of 1963
   PL: Pub.L. 110 - 233 201 Name of Law: Genetic Nondiscrimination Act of 2008
   PL: Pub.L. 107 - 174 301 Name of Law: Notification and Federal Employee Antidiscrimination and Retaliation Act of 2002
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 8060	02/11/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 32196	05/27/2022
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
NRC Form 646, "Formal Discrimination Complaint"	NRC Form 646	Formal Discrimination Complaint

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	30	30	0	0	0	0
Annual Time Burden (Hours)	30	30	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $2,880

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/20/2025

---