Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC) and Complaint of Employment Discrimination for the Decennial Census

Forms and Documents

Document Name	Status
Form CD-498 Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC) Form and Instruction	Unchanged
Form CD-498A Complaint of Employment Discrimination for the Decennial Census Form and Instruction	Unchanged
0690.0015.GINA.ChangeRequestJustiification.010710.doc Justification for No Material/Nonsubstantive Change	2010-01-07
0690.0015.SuppStmt_041508.doc Supporting Statement A	2008-04-16
DAO.215-09..doc Supplementary Document	2008-04-10
ExecOrder 11478.pdf Supplementary Document	2008-04-10

IC Document Collections

IC ID	Document Title	Status
4809	Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC) Form and Instruction	Unchanged
184426	Complaint of Employment Discrimination for the Decennial Census Form and Instruction	Unchanged

ICR Details

OMB Control No: 0690-0015	ICR Reference No: 201001-0690-001
Status: Historical Active	Previous ICR Reference No: 200802-0690-002
Agency/Subagency: DOC/OS	Agency Tracking No:
Title: Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC) and Complaint of Employment Discrimination for the Decennial Census
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/21/2010
	Date Received in OIRA: 01/07/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2011	07/31/2011	07/31/2011
Responses	700	0	700
Time Burden (Hours)	350	0	350
Cost Burden (Dollars)	0	0	0

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Abstract: Pursuant to the Equal Employment Opportunity Commission (EEOC) governing regulations found in 20 CFR 1614.106, someone alleging that they were subjected to discriminatory treatment by the Department of Commerce or one of its subagencies needs to submit a signed statement that is sufficiently precise to identify the general actions or practices that form the basis of the complaint. The complaint is also required to contain an address and phone number where the complainant or their representative may be contacted.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 20502	04/25/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 20244	04/15/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Complaint of Employment Discrimination (Used by Permanent Employees and Applicants for Employment at DOC)	CD-498	Complaint of Employment Discrimination used by Permanent Employees and Applicants for Employment at DOC
Complaint of Employment Discrimination for the Decennial Census	CD-498A	Complaint of Employment Discrimination for the Decennial Census

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	700	700	0	0	0	0
Annual Time Burden (Hours)	350	350	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a reinstatement.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/07/2010

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