RECEIPT FOR PAYMENT OF BACK WAGES (ENGLISH & SPANISH)

ICR 197910-1215-001

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
168370 Migrated
ICR Details
1215-0007 197910-1215-001
Historical Active 197806-1215-008
DOL/ESA
RECEIPT FOR PAYMENT OF BACK WAGES (ENGLISH & SPANISH)
No material or nonsubstantive change to a currently approved collection   No
Emergency 10/31/1979
Approved with change 10/31/1979
Retrieve Notice of Action (NOA) 10/31/1979
  Inventory as of this Action Requested Previously Approved
03/31/1983 03/31/1983 03/31/1983
230,000 0 250,000
19,134 0 20,800
0 0 0

FORM IS USED BY WAGE HOUR DIVISION TO VERIFY THAT EMPLOYEES DUE BACK WAGES UNDER ANY OF THE ACTS ENFORCED BY THE WAGE HOUR DIVISION HAVE RECEIVED AND ACCEPTED PAYMENT.

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 230,000 250,000 0 0 -20,000 0
Annual Time Burden (Hours) 19,134 20,800 0 0 -1,666 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.
10/31/1979


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