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Rehabilitation Maintenance Certificate
Rehabilitation Maintenance Certificate
OMB: 1215-0161
IC ID: 43809
OMB.report
DOL/ESA
OMB 1215-0161
ICR 200812-1215-006
IC 43809
( )
Documents and Forms
Document Name
Document Type
Form OWCP-17
Rehabilitation Maintenance Certificate
Form
OWCP-17 Rehabilitation Maintenance Certificate
OWCP-17.pdf
www.dol.gov/esa/owcp/dfec/regs/compliance/OWCP-17.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Rehabilitation Maintenance Certificate
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
OWCP-17
Rehabilitation Maintenance Certificate
OWCP-17.pdf
http://www.dol.gov/esa/owcp/dfec/regs/compliance/OWCP-17.pdf
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,300
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
5 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
15,600
0
0
0
0
15,600
Annual IC Time Burden (Hours)
2,605
0
0
0
0
2,605
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
