REPORT OF SECTION 10 ADJUSTMENT PAYMENTS IN SUPPORT OF CLAIM FOR REIMBURSEMENT

ICR 197312-1215-001

OMB: 1215-0065

Federal Form Document

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ICR Details
1215-0065 197312-1215-001
Historical Active
DOL/ESA
REPORT OF SECTION 10 ADJUSTMENT PAYMENTS IN SUPPORT OF CLAIM FOR REIMBURSEMENT
No material or nonsubstantive change to a currently approved collection   No
Emergency 12/06/1973
Approved with change 12/06/1973
Retrieve Notice of Action (NOA) 12/06/1973
  Inventory as of this Action Requested Previously Approved
11/30/1978 11/30/1978
4,000 0 0
466 0 0
0 0 0



None
None


No

1
IC Title Form No. Form Name
REPORT OF SECTION 10 ADJUSTMENT PAYMENTS IN SUPPORT OF CLAIM FOR REIMBURSEMENT LS 230

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,000 0 0 0 4,000 0
Annual Time Burden (Hours) 466 0 0 0 466 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/06/1973


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