SUPPORTING STATEMENT FOR VA FORM 2900-0662
Civil Rights Discrimination Complaint form 
 (2900-0662)

Summary of Changes from Previously Approved Collection
•	There have been no changes made to the form.
•	The respondent burden has not increased or decreased based on the use of the form.
•	The ownership of the form will be transferred from Human Resources and Administration/Operations, Security and Preparedness (HRA/OSP) to the Office of the Secretary (OSVA).
•	One comment was received.

    A.  JUSTIFICATION

1.	Explain the circumstances that make the collection of information necessary.  Identify legal or administrative requirements that necessitate the collection of information.  

The Department of Veterans Affairs (VA) through its OSVA administers a voluntarily complaint form for Veterans and other customers who believe their civil rights were violated while receiving medical care, services, or benefits in medical centers, facilities, clinics, offices, or institutions.    Information is requested by VA form 08-0381, Civil Rights Discrimination Complaint, under the authority of Title 38, Code of Federal Regulations, Chapter 1, Parts 15 and 18. No information is collected from the form to compile any kinds of personal data or statistics.

2.	Indicate how, by whom, and for what purposes the information is to be used; indicate actual use the agency has made of the information received from the current collection.

VA Form 8-0381 is used by Veterans and other customers (non-Federal employees or contractors) to file a formal complaint for alleged violations of their civil rights pertaining to race, color, sex, national origin, age, or disability. 

These violations are on the following statutory authorities:
•	38 CFR Ch. 1, Part 18.1—Nondiscrimination in Federally-Assisted Programs of the Department of Veterans Affairs—Effectuation of Title VI of the Civil Rights Act of 1964, Sec.602, 78 Stat. 252 (42 U.S.C. 2000d-1.
•	38 CFR Ch. 1, Part 18.401—Nondiscrimination in Federally-Assisted Programs of the Department of Veterans Affairs—Effectuation of Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. 794; 42 U.S.C. 2000d-1 to 2000d-4, 6101-6107.
•	38 CFR Ch. 1, Part 18.501—Nondiscrimination on the Basis of Age under the Age Discrimination Act of 1975 and the government wide age discrimination regulations at 45 CFR part 90.  (42 U.S.C. 6101-6107).
•	38 CFR Ch.1, Part 15—Enforcement of Nondiscrimination on the Basis of Handicap in Programs or Activities Conducted by the Department of Veterans Affairs. (29 U.S.C. 794).

3.	Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g. permitting electronic submission of responses, and the basis for the decision for adopting this means of collection.  Also describe any consideration of using information technology to reduce burden.

The use of VA Form 08-0381 does not involve the use of automated, electronic, mechanical, or other technological collection techniques or any other form of information technology.  The form may be obtained by complainants from VA Intranet Website in a fillable electronic format. Also, the Office of Resolution Management website to download from http://www.va.gov/orm/.  The form does not constitute a reporting burden; it was developed to reduce the complainant’s burden in attempting to articulate an event believed to be discriminatory.  The form helps the complainant to provide only the information necessary to make a determination whether the complaint warrants airing in a civil rights arena or in some other forum.

3.	Describe efforts to identify duplication.  Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.

Program reviews were conducted to identify potential areas of duplication; however, none were found to exist. There is no known department or agency which maintains the necessary information, nor is it available from any other source within our department.

4.	If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.
The is no additional burden on small organizations, they are generally not involved.  

6. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.

This information collection is not a recurring or repetitive report.  It is accomplished on a one-time basis per applicant.

7. Explain any special circumstances that would cause an information collection to be conducted more often than quarterly or require respondents to prepare written responses to a collection of information in fewer than 30 days after receipt of it; submit more than an original and two copies of any document; retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years; in connection with a statistical survey that is not designed to produce valid and reliable results that can be generalized to the universe of study and require the use of a statistical data classification that has not been reviewed and approved by OMB.

There are no special circumstances that require the collection to be conducted in a manner inconsistent with the guidelines in 5 CFR 1320.6.

8. If applicable, provide a copy and identify the date and page number of publications in the Federal Register of the sponsor’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB.  Summarize public comments received in response to that notice and describe actions taken by the sponsor in responses to these comments. Specifically address comments received on cost and hour burden.

A 60-Day Federal Register Notice (FRN) for the collection published on 90 FR 52793, November 21, 2025.  

One comment was received during the 60-day comment period.

A 30-Day Federal Register Notice for the collection published on (Day of the Week, Month Day, Year).  The 30-Day FRN citation is 91 FR 10447.

9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.

Decisions to provide any payment or gift to respondents does not apply.

10. Describe any assurance of privacy, to the extent permitted by law, provided to respondents and the basis for the assurance in statute, regulation, or agency policy.

Assurances of privacy are provided to complainants under the two laws governing personal information submitted to VA: The Privacy Act of 1974 (5 U.S.C. §552a), and the Freedom of Information Act (5 U.S.C. §552).  Respondents are informed that the information collected will become part of a record that complies with the Privacy Act of 1974.  These forms are part of the system of records identified as 16VA026 Litigant, Tort Claimant, EEO Complainant and Third Party Recovery Files-VA and 63VA05 Grievance Records-VA published in the Federal Register as set forth in the 2003 Compilation of Privacy Act Issuances via online GPO access at http://www.access.gpo.gov/su_docs/aces/2003_pa.html and published in the Federal Register on November 22, 2022, at 87 FR 73396.  

11. Provide additional justification for any questions of a sensitive nature (Information that, with a reasonable degree of medical certainty, is likely to have a serious adverse effect on an individual's mental or physical health if revealed to him or her), such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private; include specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.

No questions of a sensitive nature are contained on the form.

12. Estimate of the hour burden of the collection of information:

Estimate of Information Collection Burden

	a.  The estimates number of respondents is estimated at 450 annually.
     
     	b.  The frequency of response is one time.

c.  The annual burden is 113 hours. 	

d.  The estimated completion time for each form 15 minutes.

There is no expected overhead cost for completing the information collection.  Estimates the total cost for all respondents to be $1,695 (113 burden hours x $15 per hour).

13. Provide an estimate of the total annual cost burden to respondents or record-keepers resulting from the collection of information.  (Do not include the cost of any hour burden shown in Items 12 and 14).

This submission does not involve any recordkeeping costs.

14. Provide estimates of annual cost to the Federal Government.  Also, provide a description of the method used to estimate cost, which should include quantification of hours, operation expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.

Estimated Annualized Cost to the Federal Government

Grade
	Step	Burden Time
(min)	Fraction of Hour	Hourly Rate	Cost Per Response	Total Responses	Total	
7	5	15		$22.79	5.70	60	341.85	
12	5	15		 $40.42 	10.00 	60	600.00	
14	5	15		$56.80	14.20	60	852.00	
15	5	15		$66.83	16.70	60	1002.00	
Overhead at 100% Salary		
0	0	0	0	 0 	0	    0 	      $0	
Printing and Production Cost	      $0 	
Total Cost to Government	2,795.85 	

Note: The hourly wage information above is based on the hourly 2025 General Schedule (Base) Pay (SALARY TABLE 2025-GS).  This rate does not include any locality adjustment as applicable. 

The processing time estimates above are based on the actual amount of time employees of that grade level spend to process to completion a claim received on this form.

15. Explain the reason for any burden hour changes since the last submission.

There is no change in burden hours or respondent times.
											
16. For collections of information whose results will be published, 
outline plans for tabulation and publication.  Address any complex analytical techniques that will be used.  Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.

	Information collection is not for tabulation or publication use.

17. If seeking approval to not display the expiration date for OMB 
approval of the information collection, explain the reasons that display would be inappropriate.
 
We are not seeking approval to omit the expiration date for OMB approval.

18	Explain each exception to the certification statement identified in Item 
19, “Certification for Paperwork Reduction Act Submissions,” of OMB 83-I.
There is no exception to the certification statement identified in Item 19, 
"Certification for Paperwork Reduction Act Submissions," of OMB Form 83-l.

B.  COLLECTION OF INFORMATION EMPLOYING STATISTICAL METHODS

The Veteran’s Administration does not collect information employing statistical methods.