Representative Fee Request

ICR 199812-1215-003

OMB: 1215-0078

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
13741
Migrated
ICR Details
1215-0078 199812-1215-003
Historical Active 199511-1215-001
DOL/ESA
Representative Fee Request
Extension without change of a currently approved collection   No
Regular
Approved without change 01/13/1999
Retrieve Notice of Action (NOA) 12/01/1998
  Inventory as of this Action Requested Previously Approved
01/31/2002 01/31/2002 01/31/1999
14,000 0 14,000
10,000 0 10,000
17,000 0 4,000

OWCP reviews requests for approval of a fee for services provided to OWCP claimants/beneficiaries submitted by attorneys/representatives.

None
None


No

1
IC Title Form No. Form Name
Representative Fee Request

  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 14,000 14,000 0 0 0 0
Annual Time Burden (Hours) 10,000 10,000 0 0 0 0
Annual Cost Burden (Dollars) 17,000 4,000 0 13,000 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.
12/01/1998


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