NASA Complaint of Discrimination Form 1355

ICR 202310-2700-004

OMB: 2700-0163

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2023-11-06
IC Document Collections
IC ID
Document
Title
Status
219495 Modified
ICR Details
2700-0163 202310-2700-004
Received in OIRA 201806-2700-002
NASA
NASA Complaint of Discrimination Form 1355
Reinstatement with change of a previously approved collection   No
Regular 11/06/2023
  Requested Previously Approved
36 Months From Approved
60 0
30 0
0 0

This information collection is necessary to ensure compliance with the Civil Rights Act of 1964, the Equal Opportunity Act of 1972, the Age Discrimination in Employment Act of 1972, and NASA policy. NASA strives to provide and maintain a work environment that is free of all forms of discrimination, including discriminatory harassment, as well as reprisal or retaliation for engaging in protected EEO activity. NASA also seeks to address harassing conduct at the earliest possible stage, before it becomes severe or persuasive. This information collection enables NASA to obtain information, in a structured manner, from non-federal employment applicants who believe they were discriminated against based on any of the following: race, color, religion, sex (to include sexual harassment, sex stereotyping, pregnancy, and gender identity), age, national origin, disability (mental and/or physical), genetic information (including family medical history), sexual orientation, reprisal, and class complaint. Pursuant to MD-715, EEO Reporting Requirements for Federal Agencies, it is also NASA policy to promote the full realization of a model EEO program by effectively considering and addressing concerns that arise under Title VII and Section 501 of the Rehabilitation Act. NASA's efforts to be a model Agency for EEO include identification of and strategies to remove deficiencies in EEO programs and barriers to EEO in any aspect of Agency policies, programs, or practices including, but not limited to, outreach and recruiting, hiring, promoting, training, awareness, and facilities and program accessibility for employees of NASA. Model EEO efforts include monitoring strategies and employment practices in the areas of hiring, transfers, reassignments, promotions, awards, benefits, and separations. These efforts are undertaken to help gain and maintain a talented NASA workforce that is reflective of the Nation's demographic diversity. This information collection also supports NASA’s self-assessment processes in that regard.

US Code: 29 USC CFR Name of Law: Delegation of Authority to Act in Manners Pertaining to Discrimination Complaints
  
None

Not associated with rulemaking

  88 FR 60504 09/01/2023
88 FR 76259 11/06/2023
No

1
IC Title Form No. Form Name
NASA Form 1355 1355P, 1355 Complaint of Discrimination - NASA ,   Complaint of Discrimination - Public

  Total Request 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 60 0 0 0 0 60
Annual Time Burden (Hours) 30 0 0 0 0 30
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$29,768
No
    Yes
    Yes
No
No
No
No
Bill Edwards-Bodmer 757 864-9658 b.edwards-bodmer@nasa.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.
11/06/2023


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