View Information Collection Request (ICR) Package
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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:
2900-0662
ICR Reference No:
201401-2900-009
Status:
Historical Active
Previous ICR Reference No:
201104-2900-003
Agency/Subagency:
VA
Agency Tracking No:
2900-0662
Title:
Civil Rights Discrimination Complaint
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
08/11/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/24/2014
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2017
36 Months From Approved
08/31/2014
Responses
183
0
183
Time Burden (Hours)
46
0
46
Cost Burden (Dollars)
0
0
0
Abstract:
This collection is used to simplify the complainant's burden in filing a Civil Rights Discrimination complaint by identifying the information necessary to resolve the complaint.
Authorizing Statute(s):
US Code:
42 USC 2000d-1
Name of Law: Federal authority and financial assistance to programs or activities by way of grant, loan, or contr
US Code:
42 USC 2000d-2
Name of Law: Judicial review; administrative procedure provisions
US Code:
42 USC 2000d-3
Name of Law: Construction of provisions not to authorize administrative action with respect to employment practic
US Code:
42 USC 2000d-4
Name of Law: Federal authority and financial assistance to programs or activities by way of contract of insurance
US Code:
42 USC 6101
Name of Law: Statement of purpose
US Code:
42 USC 6102
Name of Law: Prohibition of discrimination
US Code:
42 USC 6103
Name of Law: Regulations
US Code:
42 USC 6104
Name of Law: Enforcement
US Code:
42 USC 6105
Name of Law: Judicial review
US Code:
42 USC 6106
Name of Law: Study of discrimination based on age
US Code:
42 USC 6107
Name of Law: Definitions
US Code:
29 USC 794
Name of Law: Nondiscrimination under Federal grants and programs
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 3270
01/17/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 30696
05/28/2014
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Civil Rights Discrimination Complaint
10-0381
Civil Rights Discrimination Complaint
ICR Summary of Burden
Total Approved
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
183
183
0
0
0
0
Annual Time Burden (Hours)
46
46
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
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:
Annual Cost to Federal Government:
$6,324
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
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?
Uncollected
Agency Contact:
Crystal Rennie 202 632-7492 crystal.rennie@va.gov
Common Form ICR:
No
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:
06/24/2014
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