Information Collection

Civil Rights Discrimination Complaint

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-0381				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 %

table that charts list of burden
	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

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.

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