Information Collection

Arbitrator's Report and Fee Statement

IC 32219 under ICR 199809-3076-003 · OMB 3076-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3076-0003 can be found here:

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IC Title:

Arbitrator's Report and Fee Statement

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	FMCS-R-19				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	4,000	-1,000	0	5,000
Annual IC Time Burden (Hours)	834	0	0	834
Annual IC Cost Burden (Dollars)	0	0	-1,000	1,000

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.