Individual Complaint of Employment Discrimination

Forms and Documents

Document	Type	Status	Availability
Form DOT F 1050–8 Individual Complaint of Employment	Form and Instruction	Modified	Available
Blank ONEDOT Formal Complaint Form 2105-0556.rtf	Supplementary Document	Uploaded 2023-04-04	Available
Supporting Statement A for 2105-0556_April 2026 (1).docx	Supporting Statement A	Uploaded 2026-07-01	Available
GINA.pdf	Supplementary Document	Uploaded 2012-10-24	Available
29 CFR Part 1614.pdf	Supplementary Document	Uploaded 2009-07-31	Available

IC Document Collections

IC ID	Collection	Type	Status	Form
44070	Individual Complaint of Employment Discrimination	Form and Instruction	Modified	Individual Complaint of Employment

ICR Details

OMB Control No: 2105-0556	ICR Reference No: 202607-2105-001
Status: Received in OIRA	Previous ICR Reference No: 202304-2105-001
Agency/Subagency: DOT/OST	Agency Tracking No:
Title: Individual Complaint of Employment Discrimination
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/13/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	244	0
Time Burden (Hours)	244	0
Cost Burden (Dollars)	2,135	0

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Abstract: The DOT will utilize the form to collect information necessary to process Equal Employment Opportunity (EEO) discrimination complaints filed by employees, former employees, and applicants for employment with the Department. These complaints are processed in accordance with the Equal Employment Opportunity Commission’s regulations, 29 CFR part 1614, as amended. The DOT will use the form to: (a) request requisite information from the individual for processing his or her EEO employment discrimination complaint; and (b) obtain information to identify an individual or his or her attorney or other representative, if appropriate.

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Authorizing Statute(s): US Code: 42 USC 2000ff Name of Law: PROHIBITING EMPLOYMENT DISCRIMINATION ON THE BASIS OF GENETIC INFORMATION
   PL: Pub.L. 110 - 233 122 STAT. 881 Name of Law: Genetic Information Nondiscrimination Act of 2008.
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 24031	05/04/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 40652	07/02/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Individual Complaint of Employment Discrimination	DOT F 1050–8	Individual Complaint of Employment

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ICR Summary of Burden

	Total Request	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	244	0	0	-31	0	275
Annual Time Burden (Hours)	244	0	0	-31	0	275
Annual Cost Burden (Dollars)	2,135	0	0	-238,490	0	240,625

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Burden reduction is hours is due to reducing the estimate number of respondents. Burden reduction in Annual Cost is due to correcting a previous error where cost per respondent was entered in ROCIS as $875 per respondent instead of $8.75 per respondent.

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Annual Cost to Federal Government: $0

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

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Common Form ICR:  No

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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: 07/13/2026

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