Information Collection

Request for Arbitration Panel, FMCS Form R-43

IC 220241 under ICR 202505-3076-005 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Form R-43 Request for Arbitration Panel 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: Modified

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: 6,000	Number of Respondents for Small Entity: 4,500

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

	Approved	Previously Approved
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	1,000	1,000
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].