OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Complaint of Discrimination Under Section 504, Section 508 or Title VI

ICR 201603-1405-005 · OMB 1405-0220 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form DS4282 Discrimination Complaint Form Form and Instruction Modified Available
1405-0220Legal Authorities 12-07.docx Supplementary Document Uploaded 2016-03-24 Repair queued
1405-0220 DS-4282 Supporting Statement Final Rule.docx Supporting Statement A Uploaded 2016-03-24 Available
IC Document Collections
IC IDCollectionTypeStatusForm
217700 Discrimination Complaint Form Form and Instruction Modified
ICR Details
1405-0220 201603-1405-005
Historical Active 201512-1405-002
STATE/AFA
Complaint of Discrimination Under Section 504, Section 508 or Title VI
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 05/25/2016
Retrieve Notice of Action (NOA) 03/24/2016
  Inventory as of this Action Requested Previously Approved
05/31/2019 36 Months From Approved
10 0 0
10 0 0
10 0 0
The DS-4282 will be used to submit complaints of discrimination under Title VI of the Civil Rights Act of 1964; and Sections 504 and 508 of the Rehabilitation Act of 1973.
US Code: 42 USC 2000 Name of Law: Title VI of the Civil Rights Act of 1964
   US Code: 29 USC 794 Name of Law: Rehabilitation Act of 1973
  
None
1400-AD87 Final or interim final rulemaking 81 FR 32645 05/24/2016
  81 FR 44 01/04/2016
No
1
IC Title Form No. Form Name
Discrimination Complaint Form DS4282 Discrimination Complaint Form
  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 10 0 0 10 0 0
Annual Time Burden (Hours) 10 0 0 10 0 0
Annual Cost Burden (Dollars) 10 0 0 10 0 0
Yes
Miscellaneous Actions
No
This is a new collection.
$1,602
No
No
No
No
No
Uncollected
Alice Kottmyer 202 647-2318 [email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
03/24/2016