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: 2900-0716	ICR Reference No: 201603-2900-017
Status: Historical Active	Previous ICR Reference No: 201412-2900-008
Agency/Subagency: VA	Agency Tracking No: 2900-0716
Title: VA Form 4939, Complaint of Employment Discrimination; VA Form 08-10192, Information for Pre-Complaint Processing
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: 12/16/2016
	Date Received in OIRA: 07/18/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved	05/31/2018
Responses	1,022	0	315
Time Burden (Hours)	512	0	158
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	1,022	315	707
Annual Time Burden (Hours)	512	158	354
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This Information Collection Request is being submitted as a revision to include VA Form 08-10192, Information for Pre-Complaint Processing. VA Form 08-10192 is the initial contact form filled out by individuals who believe they may have been discriminated against. Inclusion of this form under the OMB approval number increases the overall burden by 707 respondents.

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