Information Collection

DHS Individual Complaint of Employment Discrimination

IC 20218 under ICR 202103-1610-001 · OMB 1610-0001.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1610-0001 can be found here:

Documents and Forms

Document Name Document Type
Form DHS Form 3090-1 DHS Individual Complaint of Employment Discrimination Form and Instruction
DHS Form 3090-1 DHS Individual Compliant of Employment Discrimination DHS Form 3090-1.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DHS Individual Complaint of Employment Discrimination	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 1614

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	DHS Form 3090-1	DHS Individual Compliant of Employment Discrimination	DHS Form 3090-1.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 136	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	136	-1,064	1,200
Annual IC Time Burden (Hours)	68	-532	600
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.