Alternative Dispute Resolution Form Requests, FCC Form 5628

Alternative Dispute Resolution Form Requests, FCC Form 5628

OMB: 3060-1258

IC ID: 232542

Information Collection (IC) Details

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Alternative Dispute Resolution Form Requests, FCC Form 5628 OWD
 
No Modified
 
Voluntary
 
29 CFR 1614.603 29 CFR 1614.102 (b)(2) 29 CFR 1614.108(b) 29 CFR 1614.105(f)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form Alternate Dispute Resolution Intake Form FCC Form 5628 ADR Intake Form (final).docx Yes Yes Fillable Fileable Signable

General Government Central Fiscal Operations

FCC/OWD-2, Alternative Dispute Resolution (ADR) Program  84 FR 14374

7 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7 0 0 2 0 5
Annual IC Time Burden (Hours) 25 0 0 7 0 18
Annual IC Cost Burden (Dollars) 10,000 0 0 6,250 0 3,750

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