Information Collection

Representative Fee Request

IC 13744 under ICR 201209-1240-005 · OMB 1240-0049.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0049 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CA-143 and CA-155 Representative Fee Request	Form and Instruction
CA-143 and CA-155 Attorney Fee Request ca-143 for 1240-0049.doc	Form and Instruction

IC Title:

Representative Fee Request

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 10.700-703 20 CFR 702.132

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CA-143 and CA-155	Attorney Fee Request	ca-143 for 1240-0049.doc		No		Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL-ESA Notice 15 and DOL/GOVT-1

FR Citation: 58 FR 49599

Number of Respondents: 12,363

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,363	3,959	8,404
Annual IC Time Burden (Hours)	6,182	763	5,419
Annual IC Cost Burden (Dollars)	15,696	2,890	12,806

Documents for IC

table that charts IC Documents
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.