View Information Collection Request (ICR) Package
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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:
0508-0002
ICR Reference No:
202212-0508-001
Status:
Historical Active
Previous ICR Reference No:
202210-0508-001
Agency/Subagency:
USDA/AgOCR
Agency Tracking No:
Title:
USDA Program Discrimination Complaint Form
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/14/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/07/2022
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2024
05/31/2024
05/31/2024
Responses
278
0
278
Time Burden (Hours)
278
0
278
Cost Burden (Dollars)
0
0
0
Abstract:
The USDA needs the information from the complainant in order to respond to alleged discriminatory action.
Authorizing Statute(s):
US Code:
29 USC 794
US Code:
5 USC 301
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:
85 FR 75283
11/25/2020
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 11495
02/25/2021
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Program Discrimination Complaint Form (Individuals)
AD 3027, N/A
USDA Program Discrimination Complaint Form
,
Program Discrimination Complaint Form
Program Discrimination Complaint Form (Private Sector)
N/A, AD 3027
USDA Program Discrimination Complaint Form
,
Program Discrimination Complaint Form
Program Discrimination Complaint Form (State, Local and Tribal Government)
N/A, AD 3027
USDA Program Discrimination Complaint Form
,
Program Discrimination Complaint Form
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
278
278
0
0
0
0
Annual Time Burden (Hours)
278
278
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:
This is a revision of a currently approved information collection. There is a change in the number of respondents estimated in 2017. The number cited in this supporting statement shows an increase from 141 respondents in 2017 to a projected 278 respondents. The methodology includes an average of program complaint participants over the five-year period from 2014, 2015, 2016, 2018 and 2019. The increase in the number participants is based on the use of actual data. The increase of costs is directly associated with the increase costs of the federal salary cost and the increase of program participation.
Annual Cost to Federal Government:
$3,670
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:
Warren Brooks 202 260-3978
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:
12/07/2022
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