Alternative Dispute Resolution Form Requests, FCC Form 5628

ICR 202107-3060-005

OMB: 3060-1258

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
3060-1258 202107-3060-005
Active 201808-3060-002
Alternative Dispute Resolution Form Requests, FCC Form 5628
Extension without change of a currently approved collection   No
Approved without change 07/20/2021
Retrieve Notice of Action (NOA) 07/20/2021
  Inventory as of this Action Requested Previously Approved
07/31/2024 36 Months From Approved 10/31/2021
7 0 5
25 0 18
10,000 0 3,750

This information, completed on FCC-5628, will be used by the OWD to process, track, and maintain the confidentiality of Alternative Dispute Resolution Intake Form requests.

US Code: 5 USC 571 Name of Law: Administrative Dispute Resolution Act
   EO: EO 12988 Name/Subject of EO: Civil Justice Reform

Not associated with rulemaking

  86 FR 27432 05/20/2021
86 FR 27432 05/20/2021

IC Title Form No. Form Name
Alternative Dispute Resolution Form Requests, FCC Form 5628 Alternate Dispute Resolution Intake Form FCC Form 5628

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 7 5 0 0 2 0
Annual Time Burden (Hours) 25 18 0 0 7 0
Annual Cost Burden (Dollars) 10,000 3,750 0 0 6,250 0
The Commission is reporting adjustments to this information collection. The total number of respondents increased by +2, the total annual responses increased by +2, the total annual burden hours increased by +7 hours and the total annual costs increased by +$6,250. These calculations are based on the most currently available data to the Commission.

Cynthia Bryant 202 418-8165 [email protected]


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:
    (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;
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.

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