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Program Discrimination Complaint Form (Individuals)
USDA Program Discrimination Complaint Form
OMB: 0508-0002
IC ID: 987
OMB.report
USDA/AgOCR
OMB 0508-0002
ICR 202408-0508-001
IC 987
( )
Documents and Forms
Document Name
Document Type
Program Discrimination Complaint Form (Individuals)
Form
USDA Program Discrimination Complaint Form
AD-3027-v7-July-31-2024-Draft_EN_Fillable.pdf
Form
USDA Program Discrimination Complaint Form
AD-3027-v7-July-31-2024-Draft_EN_Fillable.pdf
Form
AD 3027 Program Discrimination Complaint Form
AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf
Form
AD 3027 Program Discrimination Complaint Form
AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf
Form
USDA Program Compl AD 3027 Spanish
AD-3027-v7-July-31-2024-Draft_ES_Fillable.pdf
Form and Instruction
USDA Program Compl AD 3027 Spanish
AD-3027-v7-July-31-2024-Draft_ES_Fillable.pdf
Form and Instruction
USDA Program Compl AD 3027 Spanish
AD-3027-v7-July-31-2024-Draft_ES_Fillable_Remediated.pdf
Form and Instruction
USDA Program Compl AD 3027 Spanish
AD-3027-v7-July-31-2024-Draft_ES_Fillable_Remediated.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Program Discrimination Complaint Form (Individuals)
Agency IC Tracking Number:
Is this a Common Form?
Yes
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
AD-3027-v7-July-31-2024-Draft_EN_Fillable.pdf
Yes
No
Fillable Printable
Form
AD 3027
Program Discrimination Complaint Form
AD-3027-v7-July-31-2024-Draft_EN_Fillable_Remediated.pdf
Yes
No
Fillable Printable
Form and Instruction
USDA Program Complaint Discrimination Form
AD 3027 Spanish
AD-3027-v7-July-31-2024-Draft_ES_Fillable.pdf
No
Fillable Printable
Form and Instruction
USDA Program Complaint Discrimination Form
AD 3027 Spanish
AD-3027-v7-July-31-2024-Draft_ES_Fillable_Remediated.pdf
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
USDA/OASCR-1, Civil Rights Enterprise System, (CRES)
FR Citation:
83 FR 65135
Number of Respondents:
158
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
158
0
0
0
158
0
Annual IC Time Burden (Hours)
158
0
0
0
158
0
Annual IC Cost Burden (Dollars)
0
0
0
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.