Information Collection

Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)

IC 4809 under ICR 202011-0690-001 · OMB 0690-0015.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0690-0015 can be found here:

Documents and Forms

Document Name Document Type
Form CD-498 Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC) Form and Instruction
CD-498 Complaint of Employment Discrimination (Used by Permanen Form CD498 (OCR Revisions submitted in Dec 2020) v2.docx Form and Instruction
CD-498 Complaint of Employment Discrimination (Used by Permanen Form CD498 (OCR Revisions submitted in Dec 2020) v2.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)	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	CD-498	Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)	Form CD498 (OCR Revisions submitted in Dec 2020) v2.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	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	200	-100	300
Annual IC Time Burden (Hours)	100	-50	150
Annual IC Cost Burden (Dollars)	0	0	0

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.