Program Discrimination Complaint Form (Individuals)

USDA Program Discrimination Complaint Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0508-0002 can be found here:

Documents and Forms

Document Name Document Type
Program Discrimination Complaint Form (Individuals) Form
USDA Program Discrimination Complaint Form USDA-OASCR P-Complaint-Form-0508-0002-508-11-28-17.pdf Form

Information Collection (IC) Details

IC Title:	Program Discrimination Complaint Form (Individuals)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 7 CFR 15.6

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	USDA Program Discrimination Complaint Form	USDA-OASCR P-Complaint-Form-0508-0002-508-11-28-17.pdf		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	80	-720	800
Annual IC Time Burden (Hours)	80	-720	800
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.