View Information Collection Request (ICR) Package

OMB Control No: 0508-0002	ICR Reference No: 202411-0508-001
Status: Active	Previous ICR Reference No: 202408-0508-001
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: Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/06/2024
	Date Received in OIRA: 12/05/2024
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2027	09/30/2027	09/30/2027
Responses	280	0	280
Time Burden (Hours)	280	0	280
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 Name of Law: Rehabilitation, Comprehensive Services, and Developmental Disabilities Act of 1978.
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:
	89 FR 41927	05/14/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 70162	08/29/2024
Did the Agency receive public comments on this ICR? Yes

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Program Discrimination Complaint Form (Individuals)	AD 3027 ENG, AD 3027 FRA, AD 3027 SPA, AD 3027 ARA, AD 3027 KOR, AD 3027 Simplified Chinese, AD 3027 URD, AD 3027 VIE, AD 3027 YID, AD 3027 HEB, AD 3027TAG, AD 3027 PUN, AD 3027 GER, AD 3027 CHIT, AD 3027 HTC, AD 3027 ITA, AD 3027 JAPANESE, AD 3027 POL, AD 3027 POL, AD 3027 RUS	, , , , , , , , , , , , , , , , , , ,
Program Discrimination Complaint Form (Private Sector)	AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediat, AD-3027-v7-July-31-2024-Draft_ES_Fillable_Remediat, AD 3027, AD 3027	, , ,
Program Discrimination Complaint Form (State, Local and Tribal Government)	AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediat, AD-3027 ES Fillable Remediated, AD 3027, AD 3027	, , ,

ICR Summary of Burden

	Total Approved	Previously Approved
Annual Number of Responses	280	280
Annual Time Burden (Hours)	280	280
Annual Cost Burden (Dollars)	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: $4,284

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: Yes
Description/Changes for Common Form Usage: The Office of the Assistant Secretary for Civil Rights (OASCR) received approval for the renewal of Agriculture Department Form # 3027. Although, OMB approved the renewal of the English version of the form with documented changes to enhance and improve the use of the form, the Spanish version of the form was inadvertently omitted from the renewal process. The renewal of the English version of this data collection form was approved on September 30, 2024, under OMB Control No. 0508-0002. Although the renewal of the English version of the form was renewed without the Spanish version, Paper-Work Reduction Act indicators (burden hours or costs to the government) are not impacted with an increase in the number languages for which the form is made available. During the renewal process OASCR embarked on the opportunity to improve the content and structure of the form based on Stakeholder input. The rationale for producing the document at a minimum of 10 languages is based on the following information. USDA provides funds an array of services that can be made accessible to otherwise eligible persons who are not proficient in the English language. USDA is committed to improving the accessibility of these services to eligible Limited English Proficiency (LEP) persons, as a goal that reinforces its equally important commitment to promoting program services. To this end, Executive Order # 13166 requires each Federal agency shall examine the services it provides and develop and implement a system by which LEP persons can meaningfully access those services consistent with, and without unduly burdening, the fundamental mission of the agency.

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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