Information Collection

Arbitrator's Report and Fee Statement

IC 32221 under ICR 200710-3076-001 · OMB 3076-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3076-0003 can be found here:

Documents and Forms

Document Name Document Type
Form R-19 Arbitrator's Report and Fee Statement Form
R-19 Arbitrator's Report and Fee Statement FormR-19Revised200301Fill.pdf www.fmcs.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Arbitrator's Report and Fee Statement	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	R-19	Arbitrator's Report and Fee Statement	FormR-19Revised200301Fill.pdf	www.fmcs.gov	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title: Privacy Act of 1974	FR Citation: 40 FR 47418

Number of Respondents: 2,500	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,500	2,500
Annual IC Time Burden (Hours)	416	416
Annual IC Cost Burden (Dollars)	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.