Information Collection

Civil Rights Discrimination Complaint

IC 28940 under ICR 202509-2900-011 · OMB 2900-0662.

Documents and Forms

Document Name Document Type
Form 10-0381 Civil Rights Discrimination Complaint Civil Rights Discrimination Complaint Form
10-0381 Civil Rights Discrimination Complaint 10-0381-fill_20140319.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Civil Rights Discrimination Complaint	Agency IC Tracking Number:	2900-0662

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 15 38 CFR 18.501 38 CFR 18.401 45 CFR 90 38 CFR 18.1

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-0381	Civil Rights Discrimination Complaint	10-0381-fill_20140319.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title: Litigant, Tort Claimant, EEO Complainant and Third Party Recovery Files-VA	FR Citation: 47 FR 8

Number of Respondents: 450	Number of Respondents for Small Entity: 1

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-450	450
Annual IC Time Burden (Hours)	-113	113
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.

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