Information Collection

Federal Government

IC 241980 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 5621 INFORMAL COMPLAINT of DISCRIMINATION Federal Government	Form
FCC Form 5621 INFORMAL COMPLAINT of DISCRIMINATION EEO Form 5621 - Informal Complaint_final version OMB approval.pdf	Form

IC Title:

Federal Government

Agency IC Tracking Number:

OWD

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 1614.106

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 5621				Yes	Yes	Fillable Fileable Signable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

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)	45	18	27
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.

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