Information Collection

Application for Mediation Services

IC 32919 under ICR 200812-3140-002 · OMB 3140-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3140-0002 can be found here:

Documents and Forms

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Document Name	Document Type

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IC Title:

Application for Mediation Services

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.8(b)(3) 5 CFR 1320.9

Information Collection Instruments:

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Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	50	-20	70
Annual IC Time Burden (Hours)	12	-5	17
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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