OMB control number
Alternative Dispute Resolution Form Requests, FCC Form 5628
OMB 3060-1258 · FCC.
OMB 3060-1258
This information will be utilized by the Equal Employment Director to pursue the resolution of general workplace disputes, encompassing both informal and formal EEO complaints, and to facilitate the Commission's Alternative Dispute Resolution process. The Commission is submitting this collection to the Office of Management and Budget for review and approval.
The latest form for Alternative Dispute Resolution Form Requests, FCC Form 5628 expires 2027-06-30 and is listed under ICR 202506-3060-007.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form Alternate Dispute FCC Form 5628 | Form |
| Nonsubstantive change request for 3060-1258 (June 2025).docx | Justification for No Material/Nonsubstantive Change |
| ADR SS_final version June 2025.docx | Supporting Statement A |
 Individuals or Households |
Information collection |
| Federal Government |
Form |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202506-3060-007 | No material or nonsubstantive change to a currently approved collection | 2025-06-24 | Approved without change | |
| 202405-3060-009 | Extension without change of a currently approved collection | 2024-06-18 | Approved without change | |
| 202107-3060-005 | Extension without change of a currently approved collection | 2021-07-20 | Approved without change | |
| 201808-3060-002 | New collection (Request for a new OMB Control Number) | 2018-08-14 | Approved without change |
OMB Details
Federal Government
Federal Enterprise Architecture: General Government - Central Fiscal Operations
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form Alternate Dispute Resolution Intake Form | FCC Form 5628 | Fillable Fileable Signable | Form |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.