REPRESENTATIVE FEE REQUEST

ICR 198110-1215-001

OMB: 1215-0115

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
122185 Migrated
ICR Details
1215-0115 198110-1215-001
Historical Active
DOL/ESA
REPRESENTATIVE FEE REQUEST
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/08/1981
Retrieve Notice of Action (NOA) 10/20/1981
  Inventory as of this Action Requested Previously Approved
09/30/1983 09/30/1983
15,000 0 0
22,500 0 0
0 0 0

ATTORNEYS AND OTHER REPRESENTATIVES REQUESTING A FEE FOR SERVICES FOR REPRESENTING A CLAIMANT IN FECA CASES BEFORE THE OFFICE OF WORKERS' COMPENSATION PROGRAMS ARE REQUIRED TO SUMIT CERTAIN SUPPORTING INFORMATION BEFORE A FEE CAN BE AUTHORIZED.

None
None


No

1
IC Title Form No. Form Name
REPRESENTATIVE FEE REQUEST ESA-CA-38

  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 15,000 0 0 0 15,000 0
Annual Time Burden (Hours) 22,500 0 0 0 22,500 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.
10/20/1981


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