Information Collection

Request for Arbitration Panel, FMCS Form R-43

IC 255768 under ICR 202207-3076-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Panel, FMCS Form R-43 Form
R-43 Request for Arbitration Panel R43 - Final.pdf Form
R-43 Request for Arbitration Panel R43 - Final.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Request for Arbitration Panel, FMCS Form R-43	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 1404

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 - Final.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records
Title: Arbitration Records SORN	FR Citation: 87 FR 16737

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	333	333
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.