Information Collection

General Complaint form

IC 251368 under ICR 202201-0581-004 · OMB 0581-0333.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0581-0333 can be found here:

Documents and Forms

Document Name Document Type
Form PSD-5001 General Complaint form Form and Instruction
PSD-5001 complaint form AMS USDA DOJ Form Page.pdf Form and Instruction
PSD-5001 complaint form AMS USDA DOJ Form Page.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	General Complaint form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	PSD-5001	complaint form	AMS USDA DOJ Form Page.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 55	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	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.