OMB control number

DHS Individual Complaint of Employment Discrimination

OMB 1610-0001 · DHS/OCR.

OMB 1610-0001

This form provides information necessary for processing formal complaints of employment discrimination in accordance with EEOC Management Directive (EEO-MD) 110, and 29 C.F.R. part 1614.

The latest form for DHS Individual Complaint of Employment Discrimination expires 2027-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form DHS Form 3090-3 DHS Individual Complaint of Employment Discrimination Form and Instruction
DHS Form 3090 (01.25.2022) (003).pdf Supplementary Document
30_Day_FRN_DHS-2023-0013-0002.pdf Supplementary Document
60_Day_FRN_DHS-2023-0013 (3).pdf Supplementary Document
1610-0001 - Supporting Statement A - DHS Individual Complaint of Employment - CRCL updates Jan2023 (1).docx Supporting Statement A
29 USC 206.pdf Supplementary Document
Executive Order 11478.docx Supplementary Document
42 USC 2000ff.pdf Supplementary Document
42 USC 2000e.pdf Supplementary Document
29 USC 791.pdf Supplementary Document
29 USC 621.pdf Supplementary Document
EEO Director 462 MEMORANDUM April 2011.pdf Supplementary Document
PART 1614--FEDERAL SECTOR EQUAL EMPLOYMENT OPPORTUNITY.pdf Supplementary Document
DHS Individual Complaint of Employment Discrimination Form and Instruction

All Historical Document Collections

202306-1610-001 Approved without change	Extension without change of a currently approved collection	2023-06-30
202103-1610-001 Approved without change	Reinstatement without change of a previously approved collection	2021-08-02
201504-1610-001 Approved without change	Reinstatement with change of a previously approved collection	2015-04-29
201106-1610-002 Approved without change	Revision of a currently approved collection	2011-06-30
200803-1610-001 Approved without change	Extension without change of a currently approved collection	2008-04-21
200501-1610-001 Approved without change	New collection (Request for a new OMB Control Number)	2005-01-11