Alternative Dispute Resolution Form Requests, FCC Form 5628

ICR 202506-3060-007

OMB: 3060-1258

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2025-06-24
Supporting Statement A
2025-06-24
IC Document Collections
IC ID
Document
Title
Status
268655
Unchanged
232542 Modified
ICR Details
3060-1258 202506-3060-007
Active 202405-3060-009
FCC OWD
Alternative Dispute Resolution Form Requests, FCC Form 5628
No material or nonsubstantive change to a currently approved collection   No
Delegated
Approved without change 06/24/2025
Retrieve Notice of Action (NOA) 06/24/2025
  Inventory as of this Action Requested Previously Approved
06/30/2027 06/30/2027 06/30/2027
3 0 3
13 0 13
3,750 0 3,750

This information will be utilized by the Equal Employment Director to pursue the resolution of general workplace disputes, encompassing both informal and formal EEO complaints, and to facilitate the Commission's Alternative Dispute Resolution process. The Commission is submitting this collection to the Office of Management and Budget for review and approval.

US Code: 5 USC 571 Name of Law: Administrative Dispute Resolution Act
   EO: EO 12988 Name/Subject of EO: Civil Justice Reform
  
None

Not associated with rulemaking

  89 FR 25263 04/10/2024
89 FR 25263 04/10/2024
No

2
IC Title Form No. Form Name
Federal Government Alternate Dispute Resolution Intake Form FCC Form 5628
Individuals or Households

  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 3 3 0 0 0 0
Annual Time Burden (Hours) 13 13 0 0 0 0
Annual Cost Burden (Dollars) 3,750 3,750 0 0 0 0
No
No

$13,990
No
    Yes
    Yes
No
No
No
No
Larry Hudson 202 418-0591 larry.hudson@fcc.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/24/2025


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