RECEIPT FOR PAYMENT OF BACK WAGES (ENGLISH & SPANISH)

ICR 197806-1215-008

OMB: 1215-0007

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
121786 Migrated
ICR Details
1215-0007 197806-1215-008
Historical Active 197603-1215-001
DOL/ESA
RECEIPT FOR PAYMENT OF BACK WAGES (ENGLISH & SPANISH)
Extension without change of a currently approved collection   No
Regular
Approved without change 07/03/1978
Retrieve Notice of Action (NOA) 06/27/1978
  Inventory as of this Action Requested Previously Approved
03/31/1983 03/31/1983 07/31/1978
250,000 0 288,000
20,800 0 24,000
0 0 0



None
None


No

1
IC Title Form No. Form Name
RECEIPT FOR PAYMENT OF BACK WAGES (ENGLISH & SPANISH) WH-58

  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 250,000 288,000 0 0 -38,000 0
Annual Time Burden (Hours) 20,800 24,000 0 0 -3,200 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.
06/27/1978


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