View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
1610-0001
ICR Reference No:
202103-1610-001
Status:
Historical Active
Previous ICR Reference No:
201504-1610-001
Agency/Subagency:
DHS/OCR
Agency Tracking No:
Title:
DHS 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:
12/03/2021
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/02/2021
Terms of Clearance:
TOC: As this collection is a repeat reinstatement, the approval is granted for a period of 18 months only. DHS should improve their monitoring of expiring information collections to avoid unnecessary reinstatement request and violation of the PRA. This collection should be reported as a violation in OMB's annual Information Collection Budget (ICB).
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2023
36 Months From Approved
Responses
136
0
0
Time Burden (Hours)
68
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
This form provides information necessary for processing formal complaints of employment discrimination in accordance with EEOC Management Directive (EEO-MD) 110, and 29 C.F.R. part 1614.
Authorizing Statute(s):
US Code:
42 USC 2000e
Name of Law: Title VII of the Civil Rights Act
US Code:
29 USC 621
Name of Law: Age Discrimination in Employment Act
US Code:
29 USC 791
Name of Law: Rehabilitation Act
US Code:
22 USC 206
Name of Law: Equal Pay Act
EO: EO 11478 Name/Subject of EO: Equal employment opportunity in the Federal Government
US Code:
42 USC 2000ff
Name of Law: Genetic Information Nondiscrimination Act (GINA)
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:
86 FR 27642
05/21/2021
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 41505
08/02/2021
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
DHS Individual Complaint of Employment Discrimination
DHS Form 3090-1
DHS Individual Compliant of Employment Discrimination
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
136
0
0
0
-1,064
1,200
Annual Time Burden (Hours)
68
0
0
0
-532
600
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:
There is a decrease in burden. The previous approval documentation mistakenly included the burden for Federal Employees. This error has been corrected, resulting in the reporting of a reduced burden.
Annual Cost to Federal Government:
$34,878
Does this IC contain surveys, censuses, or employ statistical methods?
No
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
Yes
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
Yes
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?
No
Agency Contact:
Tyrone Huff 202 447-0106 tyrone.huff@associates.dhs.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:
08/02/2021
Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.