Arbitrator's Personal Data Questionnaire

Forms and Documents

Document Name	Status
Form Form R-22 Arbitrator's Personal Data Questionnaire Form and Instruction	New
OMB Supporting Statement form 001 (2).doc Supporting Statement A	2011-09-26

IC Document Collections

IC ID	Document Title	Status
198533	Arbitrator's Personal Data Questionnaire Form and Instruction	New

ICR Details

OMB Control No: 3076-0001	ICR Reference No: 201107-3076-001
Status: Historical Inactive	Previous ICR Reference No: 200709-3076-001
Agency/Subagency: FMCS	Agency Tracking No:
Title: Arbitrator's Personal Data Questionnaire
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 09/29/2011
	Date Received in OIRA: 07/20/2011
Terms of Clearance: The agency will resubmit the ICR package as a regular review request and not a generic review request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This form provides for the operation and maintance of a roster of professional arbitrators who are available to assist governmental and private sector organizations in resolving labor disputes. The Agency uses the information supplied in this form to evaluate the credentials of applicants and determine their suitability for inclusion on the roster.

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Authorizing Statute(s): US Code: 29 USC 171(b) Name of Law: Labor Management Relations Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 28034	05/13/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 139	07/20/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Arbitrator's Personal Data Questionnaire	Form R-22	Arbitrator's Personal Data Questionnaire

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $10,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/20/2011

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