EEO Complaint Forms

ICR 201705-1505-001

OMB: 1505-0262

Federal Form Document

ICR Details
1505-0262 201705-1505-001
Active
TREAS/DO
EEO Complaint Forms
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 03/12/2019
Retrieve Notice of Action (NOA) 03/26/2018
Updated supporting statement during review.
  Inventory as of this Action Requested Previously Approved
03/31/2022 36 Months From Approved
90 0 0
47 0 0
0 0 0

Treasury employees, former employees, and applicants for employment may contact the Department’s EEO Offices if they believe they have been subjected to discrimination based on race, color, sex (includes sexual harassment, sexual orientation and gender identity), national origin, religion, disability, age (40 or over), parental status, protected genetic information, or retaliation. A Treasury staff member responsible for obtaining information regarding the claim(s) of discrimination will record on a Report of Counseling (Intake) Form the aggrieved party’s (“the aggrieved”) personal information, i.e., name, address, telephone numbers, etc., as well as the bases and issues raised by the aggrieved. Thereafter, an EEO Counselor will be assigned, who will review the information on the Report of Counseling (Intake) Form and contact the aggrieved to schedule an initial interview. This interview may include, but is not limited to: verifying the information on the Intake Form, clearly defining the scope of the issues, reviewing the rights and responsibilities of the aggrieved and the agency during the EEO complaint process including the right to representation and anonymity, the applicable time frames, the option to extend the counseling process, the right to choose between Alternative Dispute Resolution (ADR) and EEO Counseling, and the overall stages of the complaint process.

None
None

Not associated with rulemaking

  82 FR 41464 08/31/2017
83 FR 12846 03/23/2018
No

  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 90 0 0 90 0 0
Annual Time Burden (Hours) 47 0 0 47 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection

$16,000
No
    Yes
    Yes
No
No
No
Uncollected
Jennifer Leonard 202 254-6795 jennifer.leonard@hq.dhs.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.
03/26/2018


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