Information Collection

Request for Arbitration Services

IC 220241 under ICR 201908-3076-003 · OMB 3076-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3076-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form R-43 Request for Arbitration Services	Form
R-43 Request for Arbitration Panel R43_August_2019.pdf www.fmcs.gov/wp-content/uploads/2019/08/R43_August_2019.pdf	Form

IC Title:

Request for Arbitration Services

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 1401

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	R-43	Request for Arbitration Panel	R43_August_2019.pdf	https://www.fmcs.gov/wp-content/uploads/2019/08/R43_August_2019.pdf	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records

Title: Privacy Act

FR Citation: 40 FR 47418

Number of Respondents: 16,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	16,000	2,821	13,179
Annual IC Time Burden (Hours)	2,667	470	2,197
Annual IC Cost Burden (Dollars)	0	0	0

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.