Form NMB-9 Application for Alternative Dispute Resolution (ADR) Ser

Application for Alternative Dispute Resolutin (ADR) Services

Form NMB 9 Application for ADR Services

Application for Alternative Dispute Resolutin (ADR) Services

OMB: 3140-0009

Document [doc]
Download: doc | pdf

Mail:

ADR Services Fax: ADR Services 202-692-5084

National Mediation Board

Suite 250E Email: [email protected]

1301 K Street, NW

Washington, DC 20005 Phone: 202.692.5030



Form NMB-9 OMB No. 3140-0009 Expiration Date 01/31/2013



Application for ADR Services


PARTIES REQUESTING SERVICE:


Carrier Name


Organization Name


L. R. Official/Title


Organization Official/Title


Address


Address


City, State & Zip Code


City, State & Zip Code


Telephone


Telephone


Fax


Fax


Email


Email


Signature of Carrier Official/ Representative


Signature of Organization Official/ Representative


Date


Date



  1. Fully complete the above information for your company/organization and also the name, phone number, and company/organization of the other party.

  2. The NMB requires an application from each party with a signature before services are scheduled.

  3. Select the type of ADR service(s) below by placing a in the appropriate box.


TYPE OF ADR SERVICE REQUESTED:



Facilitation Services


Grievance Mediation Services


Grievance Mediation Training


Interest Based Bargaining (IBB) Training


On-Line Dispute Resolution (ODR) Training


Preparation for Mediation Training


Other: (describe)




Class or Craft:

Number of Employees:

Number of Participants (Training Only):



Instructions:

  1. ADR services are voluntary; both parties must be interested in participating before services are scheduled.

  2. Complete application in full.

  3. Fax, E-mail, or Mail to ADR Services. (See e-mail address, fax number and mailing address above.)



According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is 3140-0002. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.


Revised September 2009

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Last Modified Bydv212
File Modified2010-01-05
File Created2004-05-27

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