Information Collection

Discrimination Complaint Form

IC 217700 under ICR 201905-1405-005 · OMB 1405-0220.

Documents and Forms

Document Name Document Type
Form DS4282 Discrimination Complaint Form Form and Instruction
DS4282 Discrimination Complaint Form DS-4282.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Discrimination Complaint Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	DS4282	Discrimination Complaint Form	DS-4282.pdf		Yes	No	Fillable Printable

Line of Business: Litigation and Judicial Activities

Subfunction: Legal Investigation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	10	10
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	10	10

Documents for IC

Title	Document	Date Uploaded
No associated records found

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