Title II of the Americans with Disabilities Act of 1990/Section 504 Rehabilitation Act of 1973 Discrimination Complaint Form

ICR 201201-1190-001

OMB: 1190-0009

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2012-04-23
Supporting Statement A
2012-04-26
Supplementary Document
2012-01-24
Supplementary Document
2010-05-26
Supplementary Document
2010-05-26
ICR Details
1190-0009 201201-1190-001
Historical Active 201005-1190-003
DOJ/CRT
Title II of the Americans with Disabilities Act of 1990/Section 504 Rehabilitation Act of 1973 Discrimination Complaint Form
Extension without change of a currently approved collection   No
Regular
Approved with change 05/02/2012
Retrieve Notice of Action (NOA) 01/26/2012
We encourage the agency to make this form fully electonic by the next submission, consistent with the agency's plan as stated in the supporting statement.
  Inventory as of this Action Requested Previously Approved
05/31/2015 36 Months From Approved 05/31/2012
5,000 0 5,000
3,750 0 3,750
0 0 0

Under title II of the Americans with Disabilities Act, an individual who believes that he or she has been subjected to discrimination on the basis of disability by a public entity may, by himself or herself or by an authorized representative, file a complaint. This information collection form has been developed to simplify this process for complainants.

US Code: 42 USC 12131 Name of Law: Americans with Disabilities Act
  
None

Not associated with rulemaking

  76 FR 67208 10/31/2011
77 FR 1084 01/09/2012
Yes

  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 5,000 5,000 0 0 0 0
Annual Time Burden (Hours) 3,750 3,750 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$196,500
No
No
No
No
No
Uncollected
Jonathan Hahm 202 256-3307 jonathan.hahm@usdoj.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.
01/26/2012


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