Representative Fee Request

Representative Fee Request

OMB: 1215-0078

IC ID: 13744

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Representative Fee Request
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 10.700-703 20 CFR 702.132

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ca-143 attorney fee request ca-143 10-29-09 for 1215-0078.doc No   Paper Only

Health Health Care Services

DOL-ESA Notice 15 and DOL/GOVT-1  58 FR 49599

8,404 0
   
Private Sector Businesses or other for-profits
 
   0 %

  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 8,404 0 0 -3,936 0 12,340
Annual IC Time Burden (Hours) 5,419 0 0 -2,256 0 7,675
Annual IC Cost Burden (Dollars) 12,806 0 0 -4,595 0 17,401

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.

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