Information Collection

DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver Form

IC 247887 under ICR 202205-1601-003 · OMB 1601-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1601-0035 can be found here:

Documents and Forms

Document Name Document Type
DHS Form XXX_Civil Rights Complaint.pdf www.dhs.gov/file-civil-rights-complaint Other-website
DHS_CRCL_Civil Rights Complaint Form_8-1-22.pdf www.dhs.gov/file-civil-rights-complaint Other-website

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DHS Civil Rights and Civil Liberties Complaint and Privacy Waiver 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
Other-website			DHS_CRCL_Civil Rights Complaint Form_8-1-22.pdf	https://www.dhs.gov/file-civil-rights-complaint	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title: DHS ALL-029 Civil Rights and Civil Liberties Records System of Records	FR Citation: 86 FR 33331

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	2,000	2,000
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.