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Persons are not required to respond to a collection of information
unless it displays a currently valid OMB control number. Pursuant to 29 CFR
§ 37.37(c), completing this log is required to obtain or retain
benefits under the Workforce Investment Act of 1998. The Department of Labor's
Civil Rights Center will use the information to identify any patterns of
discrimination that may exist within a particular program, and to ensure that
individuals who file complaints alleging discrimination with the recipient are
afforded due process in that the complaint is processed in a accordance with
the nondiscrimination and equal opportunity provisions of the Workforce
Investment Act of 1998 for complaint processing procedures. Average response
time is estimated to be 3 minutes for each compliant entry. Send comments
regarding this estimate or any other aspects of this collection of information
to the U.S. Department of Labor, Office of the Assistant Secretary for
Administration and Management, Civil Rights Center, Room N-4123, Washington,
D.C. 20210. Please reference OMB control number 1225-0077 expiration date 5/31/2011. |
|
Date of Complaint |
Name of Complainant |
Address of Complainant |
Status of Complainant |
DOL-funded Program |
Date of the Alleged Discrimatory Incident |
Grounds/ (Bases) of Complaint |
Description/Issue of Complaint |
Name of Respondent |
Is Respondent a recipient? Yes or No |
Disposition |
Date of Disposition |
ADR Yes or No |
