Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form

Forms and Documents

Document Name	Status
Form OMB Number 1190-00 Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form Form and Instruction	Unchanged
Memo ROCIS.pdf Justification for No Material/Nonsubstantive Change	2017-01-18
Charge Form_Name Change Update.pdf Supplementary Document	2017-01-18
1190-0018_OMB 83i Form OSC_061516.pdf Supplementary Document	2016-06-16
1190-0018_Consultations Outside the Agency_061616.doc Supplementary Document	2016-06-16
1190-0018 Justification re no expiration date_061516.doc Supplementary Document	2016-06-16
28 CFR PART 44_021313.pdf Supplementary Document	2013-02-13
8 USC 1324b_021313.pdf Supplementary Document	2013-02-13
1190-0018_83i Form_100914.pdf Supplementary Document	2014-10-09
1190-0018 Supporting Statement_061516.doc Supporting Statement A	2016-06-16

IC Document Collections

IC ID	Document Title	Status
205699	Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form Form and Instruction	Unchanged

ICR Details

OMB Control No: 1190-0018	ICR Reference No: 201701-1190-003
Status: Historical Inactive	Previous ICR Reference No: 201603-1190-001
Agency/Subagency: DOJ/CRT	Agency Tracking No:
Title: Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted and continue	Conclusion Date: 01/30/2017
	Date Received in OIRA: 01/18/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2019	36 Months From Approved	09/30/2019
Responses	210	0	210
Time Burden (Hours)	105	0	105
Cost Burden (Dollars)	0	0	0

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Abstract: Under 8 U.S.C. § 1324b of the Immigration and Nationality Act, the United States Department of Justice, Civil Rights Division, Office of Special Counsel for Immigration-Related Unfair Employment Practices (OSC) requires information on citizenship status, immigration status, national origin, and the nature, timing, and specifics of the alleged discriminatory acts from charging parties alleging discrimination in order to determine jurisdiction over the allegation of employment discrimination and to initiate an investigation based on the allegation.

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Authorizing Statute(s): US Code: 8 USC 13224b Name of Law: Immigration and Nationality Act
  

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:
	81 FR 24129	04/25/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 42726	06/30/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Office of Special Counsel for Immigration-Related Unfair Employment Practices Charge Form	OMB Number 1190-0018	OSC Charge Form

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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:

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Annual Cost to Federal Government: $10,626

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 01/18/2017

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