Information Collection

Arbitrator's Report and Fee Statement

IC 32221 under ICR 202202-3076-001 · OMB 3076-0003.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3076-0003 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form R-19 Arbitrator's Report and Fee Statement	Form
R-19 Arbitrator's Report and Fee Statement Form R-19 Final.pdf www.fmcs.gov/services/arbitration/information-fmcs-roster-arbitrators/	Form
R-19 Arbitrator's Report and Fee Statement Form R-19 Final.pdf www.fmcs.gov/services/arbitration/information-fmcs-roster-arbitrators/	Form

IC Title:

Arbitrator's Report and Fee Statement

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 1404

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-19	Arbitrator's Report and Fee Statement	Form R-19 Final.pdf	www.fmcs.gov/services/arbitration/information-fmcs-roster-arbitrators/	Yes	Yes	Fillable Fileable Signable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records

Title: Arbitration SORN

FR Citation: 87 FR 16737

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	2,000	0	2,000
Annual IC Time Burden (Hours)	333	-1	334
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.