Information Collection

Request for Arbitration Services

IC 220241 under ICR 201908-3076-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 R-43 Request for Arbitration Services Form
R-43 Request for Arbitration Panel R43_August_2019.pdf www.fmcs.gov/wp-content/uploads/2019/08/R43_August_2019.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: Modified

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	R-43	Request for Arbitration Panel	R43_August_2019.pdf	https://www.fmcs.gov/wp-content/uploads/2019/08/R43_August_2019.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: 16,000	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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	16,000	2,821	13,179
Annual IC Time Burden (Hours)	2,667	470	2,197
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.