View Information Collection (IC)

View Information Collection (IC)

Individual Complaint of Employment Discrimination
 
No Modified
 
Voluntary
 
29 CFR 1614

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form DOT Form 1050-1 EEO COUNSELOR CHECKLIST DOT Form 1050-1 - EEO Counselor Checklist.docx Yes Yes Fillable Printable
Form DOT Form 1050-2 Mediation Intake.doc DOT Form 1050-2- Mediation Intake.doc Yes Yes Fillable Printable
Form DOT Form 1050-3 Agreement to Mediate DOT Form 1050-3 - Agreement to Mediate.docx Yes Yes Fillable Printable
Form DOT Form 1050-4 Exit Survey for Mediation Participants DOT Form 1050-4 - Exit Survey for Mediation Participants.doc Yes Yes Fillable Printable
Form DOT Form 1050-6 NOTICE OF RIGHT TO FILE A DISCRIMINATION COMPLAINT DOT Form 1050-6 - NOTICE OF RIGHT TO FILE A DISCRIMINATION COMPLAINT.docx Yes Yes Fillable Printable
Form DOT Form 1050-5 Extension of EEO Counseling DOT Form 1050-5 - Extension of EEO Counseling.docx Yes Yes Fillable Printable
Form DOT Form 1050-7 Notice of Rights and Responsibilities DOT Form 1050-7 - Notice of Rights and Responsibilities.doc Yes Yes Fillable Printable
Form and Instruction DOT Form 1050-8 Individual Complaint of Employment DOT Form 1050-8 - Individual Complaint of Employment Discrimination.doc Yes Yes Fillable Printable
Form DOT Form 1050-9 DESIGNATION OF REPRESENTATIVE FORM DOT Form 1050-9 - DESIGNATION OF REPRESENTATIVE FORM.docx Yes Yes Fillable Printable
Form DOT Form 1050-10 Final Agency Decision Request Form DOT Form 1050-10 - Final Agency Decision Request Form.doc Yes Yes Fillable Printable
Form DOT Form 1050-11 WAIVER OF RIGHT TO ANONYMITY DOT Form 1050-11 - WAIVER OF RIGHT TO ANONYMITY.docx Yes Yes Fillable Printable
Form DOT Form 1050-12 Request for Mediation DOT Form 1050-12 - Request for Mediation.docx Yes Yes Fillable Printable

Workforce Management Labor Rights Management

 

10 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10 0 0 0 10 0
Annual IC Time Burden (Hours) 30 0 0 20 10 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.