Information Collection

Request for Arbitration Services

IC 220241 under ICR 201602-3076-002 · OMB 3076-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3076-0016 can be found here:

Documents and Forms

Document Name Document Type
Form From R-43 Request for Arbitration Services Form
From R-43 Request for Arbitration Services Form_R-43_Expires_09-30-2014.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Arbitration Services	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 1401

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	From R-43	Request for Arbitration Services	Form_R-43_Expires_09-30-2014.pdf		Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

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

Number of Respondents: 13,179	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,179	13,179
Annual IC Time Burden (Hours)	2,197	2,197
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.