Information Collection

Individuals or Households

IC 226756 under ICR 202601-3060-012 · OMB 3060-1237.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form FCC Form 5622 FORMAL COMPLAINT OF DISCRIMINATION Individuals or Households	Form
FCC Form 5622 FORMAL COMPLAINT OF DISCRIMINATION FCC FORMAL COMPLAINT FORM_final version OMB approval.pdf	Form

IC Title:

Agency IC Tracking Number:

OWD

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 1614.105

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	FCC Form 5622				Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title: EEOC/GOVT-1, Equal Opportunity in the Federal Government

FR Citation: 81 FR 81116

Number of Respondents: 11

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	11	3	8
Annual IC Time Burden (Hours)	44	18	26
Annual IC Cost Burden (Dollars)	13,000	7,000	6,000

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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].