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OMB Control No: 2900-0662	ICR Reference No: 202509-2900-011
Status: Received in OIRA	Previous ICR Reference No: 202209-2900-012
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	Date Submitted to OIRA: 03/04/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2026
Responses	450	450
Time Burden (Hours)	113	113
Cost Burden (Dollars)	0	0

Authorizing Statute(s): 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
   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-3 Name of Law: Construction of provisions not to authorize administrative action with respect to employment practic
   US Code: 42 USC 6102 Name of Law: Prohibition of discrimination
   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 2000d-2 Name of Law: Judicial review; administrative procedure provisions
   US Code: 42 USC 6103 Name of Law: Regulations

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Request	Previously Approved
Annual Number of Responses	450	450
Annual Time Burden (Hours)	113	113
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: Leadership has decided to modify the format to enhance user-friendliness for both civilians and employees who are addressing inquiries. It is important to note that there has been no change in the workload. Furthermore, I uploaded two documents containing identical information, which led the system to erroneously interpret that I had submitted a greater number of burden entries than intended.

Annual Cost to Federal Government: $0

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. No

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: Denise DeShields 202 461-7840 denise.deshields@va.gov

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