Resubmission Turnaround Document

ICR 199710-1215-003

OMB: 1215-0177

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
13889 Migrated
ICR Details
1215-0177 199710-1215-003
Historical Active 199409-1215-001
DOL/ESA
Resubmission Turnaround Document
Extension without change of a currently approved collection   No
Regular
Approved without change 12/08/1997
Retrieve Notice of Action (NOA) 10/23/1997
  Inventory as of this Action Requested Previously Approved
12/31/2000 12/31/2000 12/31/1997
30,000 0 30,000
2,500 0 2,500
0 0 0

The Resubmission Turnaround Document (RTD) is a computer-generated form used to collect incorrect or missing information from the OWCP-1500 or OWCP-92 that is necessary for processing medical treatment bills for payment.

None
None


No

1
IC Title Form No. Form Name
Resubmission Turnaround Document CM-1173

  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 30,000 30,000 0 0 0 0
Annual Time Burden (Hours) 2,500 2,500 0 0 0 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.
10/23/1997


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