View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 2105-0556	ICR Reference No: 201210-2105-001
Status: Historical Active	Previous ICR Reference No: 200907-2105-002
Agency/Subagency: DOT/OST	Agency Tracking No:
Title: Individual Complaint of Employment Discrimination
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/19/2013
	Date Received in OIRA: 03/13/2013
Terms of Clearance: OMB notes this collection expired without DOT discontinuing it, which is a violation of PRA procedures. If DOT decides to request extension of this collection, it must enter the burden estimates for each IC in ROCIS (rather than uploading them all under one burden estimate) and include an estimate of the cost of this collection to the Federal gov't. This collection is approved for one year.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2014	36 Months From Approved
Responses	10	0	0
Time Burden (Hours)	30	0	0
Cost Burden (Dollars)	0	0	0

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

IC Title	Form No.	Form Name
Individual Complaint of Employment Discrimination	DOT Form 1050-1 , DOT Form 1050-9, DOT Form 1050-2, DOT Form 1050-3 , DOT Form 1050-4, DOT Form 1050-6, DOT Form 1050-5, DOT Form 1050-7 , DOT Form 1050-8, DOT Form 1050-10, DOT Form 1050-11, DOT Form 1050-12	, , , , , , , , , , ,

ICR Summary of Burden

	Total Approved	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	10	0	10
Annual Time Burden (Hours)	30	20	10
Annual Cost Burden (Dollars)	0	0	0

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: No

Burden Reduction Due to:

Short Statement: DOT has changed the hours necessary for completing the forms since the OMB&amp;amp;amp;#039;s approval of the form in 2009. This includes the addition of DOT Form 1050-11 (&amp;amp;amp;quot;Waiver of Right to Anonymity&amp;amp;amp;quot;) and DOT Form 1050-12 (&amp;amp;amp;quot;Request for Mediation&amp;amp;amp;quot;). However, prior to 2009 the number of hours necessary for completing the form was changed from 2.5 hours to 1 hour. The reduction of 1.5 hours was based on the erroneous focus on only DOT F 1050-8, without factoring in the time required for the remaining forms.

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