Information Collection

Discrimination Complaint Form

IC 9559 under ICR 200102-0960-002 · OMB 0960-0585.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0585 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	Discrimination Complaint Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	SSA-437				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	300	50	250
Annual IC Time Burden (Hours)	300	50	250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.