Rehabilitation Maintenance Certificate

ICR 200606-1215-003

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
43809 Migrated
ICR Details
1215-0161 200606-1215-003
Historical Active 200307-1215-002
DOL/ESA
Rehabilitation Maintenance Certificate
Extension without change of a currently approved collection   No
Regular
Approved without change 08/28/2006
Retrieve Notice of Action (NOA) 06/15/2006
  Inventory as of this Action Requested Previously Approved
08/31/2009 36 Months From Approved 08/31/2006
15,600 0 15,600
2,605 0 2,605
0 0 0

The OWCP-17 serves as a bill submitted by the program participant or OWCP, requesting reimbursement of expenses incurred due to participation in an approved rehabilitation effort for the preceding four week period of fraction thereof.

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 15,600 15,600 0 0 0 0
Annual Time Burden (Hours) 2,605 2,605 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.
06/15/2006


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