E-58 cover letter

U.S. Department of Justice
Executive Office for Immigration Review
Office of the General Counsel
5107 Leesburg Pike, Suite 2600
Falls Church, Virginia 22041

July 14, 2015
MEMORANDUM TO:

Lynn Murray
Department Clearance Officer
Department of Justice

FROM:

Christina Baptista
Associate General Counsel
Executive Office for Immigration Review

SUBJECT:

Request for Approval of a New Collection for the Unfair
Immigration-Related Employment Practices Complaint Form

Attached is the information collection request (ICR) for the Unfair Immigration-Related
Employment Practices Complaint Form (EOIR-58), as required for certification and submission
to the Office of Management and Budget. The purpose of the information collection is to allow
individuals who believe they have suffered employment discrimination in violation of INA
§ 274B to file a complaint directly with EOIR’s Office of the Chief Administrative Hearing
Officer (OCAHO).
The following documents are contained in this ICR package:
1.
2.
3.
4.
5.
6.
7.

OMB form 83-I Paperwork Reduction Act Submission;
Supporting Statement for Paperwork Reduction Act Submission with burden
statement;
Certification Statement;
Form and Instructions used to collect the information;
Additional law or authority mandating the information collection;
Copy of the 60-day Federal Register notice, 80 FR 99, 29340; and
30-day ICR notice that will be published in the Federal Register.

If you have any questions concerning this ICR, please contact Christina Baptista at
(703) 305-0992 or at Christina.Baptista@usdoj.gov. Thank you very much for all of your
assistance.
Attachments