Information Collection

Employee Claim for Wage Restitution

IC 182985 under ICR 201407-1600-001 · OMB 1600-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1600-0002 can be found here:

Documents and Forms

Document Name Document Type
Form DHS 700-4 Employee Claim for Wage Restitution Form
DHS 700-4 Employee Claim for Wage Restitution DHS Form 700-4.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Employee Claim for Wage Restitution	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DHS 700-4	Employee Claim for Wage Restitution	DHS Form 700-4.pdf		Yes	No	Fillable Printable

Line of Business: Supply Chain Management

Subfunction: Services Acquisition

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 41	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	41	10	31
Annual IC Time Burden (Hours)	41	10	31
Annual IC Cost Burden (Dollars)	0	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.