Information Collection

ADR Election Form

IC 230727 under ICR 202207-1505-002 · OMB 1505-0262.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1505-0262 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TD F 62-03.11 ADR Election Form	Form
TD F 62-03.11 ADR Election Form ADR Election Form 62-03.11 2022.pdf	Form
TD F 62-03.11 ADR Election Form ADR Election Form 62-03.11 2022.pdf	Form

IC Title:

ADR Election Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 29 CFR 1614

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	TD F 62-03.11	ADR Election Form	ADR Election Form 62-03.11 2022.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records

Title: Department of the Treasury, Civil Rights, Complaints and Compliance Review Files System of Records Notice

FR Citation: 81 FR 78266

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	0	0
Annual IC Cost Burden (Dollars)	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.