Representative Fee Request

ICR 199910-1215-002

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
13742 Migrated
ICR Details
1215-0078 199910-1215-002
Historical Active 199812-1215-003
DOL/ESA
Representative Fee Request
Revision of a currently approved collection   No
Regular
Approved without change 12/29/1999
Retrieve Notice of Action (NOA) 10/29/1999
  Inventory as of this Action Requested Previously Approved
12/31/2002 12/31/2002 01/31/2002
13,720 0 14,000
9,860 0 10,000
17,000 0 17,000

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 CA-143, CA-1066

  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 13,720 14,000 0 -280 0 0
Annual Time Burden (Hours) 9,860 10,000 0 -140 0 0
Annual Cost Burden (Dollars) 17,000 17,000 0 0 0 0
No
Yes

$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.
10/29/1999


© 2024 OMB.report | Privacy Policy