Workplace Discrimination Complaints

Forms and Documents

Document Name	Status
Form FCC Form 5621 Federal Government Form	Modified
Form FCC Form 5622 Individuals or Households Form	Modified
Informal and Formal Complaint Forms Non-substantive Modification Justification.docx Justification for No Material/Nonsubstantive Change	2022-06-21
Supporting Statement Forms 5621 and 5622 Workplace Discrimination_052020.docx Supporting Statement A	2020-05-28

IC Document Collections

IC ID	Document Title	Status
241980	Federal Government Form	Modified
226756	Individuals or Households Form	Modified

ICR Details

OMB Control No: 3060-1237	ICR Reference No: 202206-3060-015
Status: Active	Previous ICR Reference No: 202004-3060-043
Agency/Subagency: FCC	Agency Tracking No: OWD
Title: Workplace Discrimination Complaints
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/21/2022
	Date Received in OIRA: 06/21/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2023	05/31/2023	05/31/2023
Responses	23	0	23
Time Burden (Hours)	67	0	67
Cost Burden (Dollars)	8,000	0	8,000

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Abstract: The Commission is requesting approval for non-substantive changes to the forms associated with the FCC’s Informal Complaint of Discrimination (FCC Form 5621) and the FCC’s Formal Complaint of Discrimination (FCC Form 5622). As part of the development of an online application for its informal and formal complaint process, the FCC discovered that there were inconsistencies in the Privacy Act Statements included on these forms and the FCC’s online application for submitting complaints which could prove confusing to complainants, and could potentially provide insufficient information about the Privacy Act routine uses and whether submitting information is mandatory or voluntary. To remedy this issue, the FCC has revised its Privacy Act Statements on both forms. The updates to this collection will cause no change in the burden estimates or reporting and record keeping requirements that the Commission submitted (and which OMB subsequently approved) in 2017 and extended in 2020. FCC employees, former employees and applicants for employment who believe they were denied equal employment opportunity based on race, color, religion, gender, national origin, age, physical or mental disability, genetic information and/or reprisal will complete FCC-5621 and FCC-5622.

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Authorizing Statute(s): US Code: 42 USC 2000ff-6(f)
   US Code: 29 USC 206(d)
   US Code: 29 USC 6333a
   US Code: 29 USC 791
   US Code: 29 USC 794a
   US Code: 42 USC 2000e-16
  

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:
	85 FR 16625	03/24/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 16625	03/24/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Federal Government	FCC Form 5621	INFORMAL COMPLAINT of DISCRIMINATION
Individuals or Households	FCC Form 5622	FORMAL COMPLAINT OF DISCRIMINATION

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ICR Summary of Burden

	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	23	23	0	0	0	0
Annual Time Burden (Hours)	67	67	0	0	0	0
Annual Cost Burden (Dollars)	8,000	8,000	0	0	0	0

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: The Commission is reporting an adjustment to this information collection. The total number of respondents and total annual responses decreased by 3, the total annual burden hours decreased by 24 hours and the total annual costs decreased by $7,000. These decreases are based on the most currently available data to the Commission.

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Annual Cost to Federal Government: $226,961

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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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: 06/21/2022

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