Workplace Discrimination Complaints

Forms and Documents

Document	Type	Status	Availability
Form FCC Form 5621 INFORMAL COMPLAINT of DISCRIMINATION	Form	Modified	Available
Form FCC Form 5622 FORMAL COMPLAINT OF DISCRIMINATION	Form	Modified	Available
NCR for OMB Control Number 3060-1237.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-04-30	Available
Supporting Statement Forms 5621 and 5622 Workplace Discrimination_final version.docx	Supporting Statement A	Uploaded 2023-05-26	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
241980	Federal Government	Form	Modified	INFORMAL COMPLAINT of DISCRIMINATION
226756	Individuals or Households	Form	Modified	FORMAL COMPLAINT OF DISCRIMINATION

ICR Details

OMB Control No: 3060-1237	ICR Reference No: 202504-3060-007
Status: Historical Active	Previous ICR Reference No: 202305-3060-014
Agency/Subagency: FCC	Agency Tracking No: OWD
Title: Workplace Discrimination Complaints
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/30/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/30/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	05/31/2026	05/31/2026
Responses	16	0	16
Time Burden (Hours)	53	0	53
Cost Burden (Dollars)	12,000	0	12,000

---

Abstract: In accordance with Executive Order (EO) 14168, Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, the Federal Communications Commission (FCC) is submitting a non-substantive change request for OMB Control Number 3060-1237, Workplace Discrimination Complaints. FCC Form 5621, Informal Complaint of Discrimination and FCC Form 5622, Formal Complaint of Discrimination have been updated to comply with this EO. There are no changes in the burdens or costs to this information collection. This information will be used by the OWD to seek resolution of, investigate, and issue Final Agency Decisions regarding allegations of discrimination and/or retribution or reprisals towards FCC employees, former employees or applicants (respondents) for employment at the FCC.

---

Authorizing Statute(s): US Code: 29 USC 206(d)
   US Code: 29 USC 633a
   US Code: 29 USC 791
   US Code: 29 USC 794a
   US Code: 42 USC 2000ff-6(f)
   US Code: 42 USC 2000e-16
  

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:
	88 FR 19141	03/30/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 19141	03/30/2023
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Federal Government	FCC Form 5621	INFORMAL COMPLAINT of DISCRIMINATION
Individuals or Households	FCC Form 5622	FORMAL COMPLAINT OF DISCRIMINATION

---

ICR Summary 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	16	16	0	0	0	0
Annual Time Burden (Hours)	53	53	0	0	0	0
Annual Cost Burden (Dollars)	12,000	12,000	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: The Commission is reporting adjustments to this information collection. The total number of respondents and total annual responses decreased by 7, the total annual burden hours decreased by 14 hours and the total annual costs increased by $4,000. These calculations are based on the most currently available data to the Commission

---

Annual Cost to Federal Government: $191,927

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: 04/30/2025

---