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Federal forms, ICRs, and supporting documents

Information Collection Request

OWCP REPRESENTATIVE FEE REQUEST: FECA (CA-38), BLACK LUNG (CM-972), AND LONGSHORE (20 CFR 702.132) PROGRAMS

ICR 198501-1215-002 · OMB 1215-0078 · Historical Active

Forms and Documents
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IC IDCollectionTypeStatusForm
122084 OWCP REPRESENTATIVE FEE REQUEST: FECA (CA-38), BLACK LUNG (CM-972), AND LONGSHORE (20 CFR 702.132) PROGRAMS Form Migrated
ICR Details
1215-0078 198501-1215-002
Historical Active 198309-1215-032
DOL/ESA
OWCP REPRESENTATIVE FEE REQUEST: FECA (CA-38), BLACK LUNG (CM-972), AND LONGSHORE (20 CFR 702.132) PROGRAMS
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 03/26/1985
Retrieve Notice of Action (NOA) 01/22/1985
  Inventory as of this Action Requested Previously Approved
09/30/1986 09/30/1986
14,500 0 0
10,183 0 0
0 0 0
REQUESTS SUBMITTED FOR APPROVAL OF A FEE FOR SERVICES PROVIDED OWCP CLAIMANT/BENEFICIARIES SUBMITTED BY ATTORNEY/REPRESENTATIVE.
None
None
No
1
IC Title Form No. Form Name
OWCP REPRESENTATIVE FEE REQUEST: FECA (CA-38), BLACK LUNG (CM-972), AND LONGSHORE (20 CFR 702.132) PROGRAMS CM-972, (BL), CA-38 (FECA)
  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 14,500 0 0 0 14,500 0
Annual Time Burden (Hours) 10,183 0 0 0 10,183 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  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.
01/22/1985