Information Collection Request

Civil Rights Discrimination Complaint

ICR 202209-2900-012 · OMB 2900-0662 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 2900-0662 can be found here:

Forms and Documents

Document Name	Status
Form 10-0381 Civil Rights Discrimination Complaint Form	Modified
2022-25996 30 days.pdf Supplementary Document	2022-11-29
30-Day Civil Rights Discrimination Complaint.docx Supplementary Document	2022-11-23
2022-20916 Public 60 day Federal notices.pdf Supplementary Document	2022-11-23
Supporting Statement A.docx Supporting Statement A	2022-11-29

IC Document Collections

IC ID	Document Title	Status
28940	Civil Rights Discrimination Complaint Form	Modified

ICR Details

Status	Received in OIRA
Agency/Subagency	VA
OMB Control No	2900-0662
Type of Information Collection	Reinstatement with change of a previously approved collection
Previous ICR Reference No	201401-2900-009
Agency Tracking No	2900-0662
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31