REHABILITATION MAINTENANCE CERTIFICATE

ICR 198908-1215-004

OMB: 1215-0161

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
122333 Migrated
ICR Details
1215-0161 198908-1215-004
Historical Active 198610-1215-006
DOL/ESA
REHABILITATION MAINTENANCE CERTIFICATE
Revision of a currently approved collection   No
Regular
Approved without change 11/01/1989
Retrieve Notice of Action (NOA) 08/08/1989
  Inventory as of this Action Requested Previously Approved
11/30/1992 11/30/1992 10/31/1989
11,400 0 4,200
1,904 0 700
0 0 0

THE FORM OWCP-17 SERVES AS A BILL SUBMITTED BY THE DISABLED WORKER TO OWCP REQUESTING REIMBURSEMENT OF EXPENSES INCURRED DUE TO PARTICIPATIO IN AN APPROVED REHABILITATION EFFORT FOR THE PRECEDING FOUR WEEK PERIO

None
None


No

1
IC Title Form No. Form Name
REHABILITATION MAINTENANCE CERTIFICATE OWCP-17

  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 11,400 4,200 0 0 7,200 0
Annual Time Burden (Hours) 1,904 700 0 0 1,204 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.
08/08/1989


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