Information Collection

Agreement to Extend Counseling to Participate in Mediation

IC 230730 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form TD F 62-03.4 Agreement to Extend Counseling to Participate in Mediation Form and Instruction
TD F 62-03.4 Agreement to Extend Counseling to Participate in Mediati Agreement to Extend Counseling with Mediation 62-03.4 2022.pdf Form and Instruction
TD F 62-03.4 Agreement to Extend Counseling to Participate in Mediati Agreement to Extend Counseling with Mediation 62-03.4 2022.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Agreement to Extend Counseling to Participate in Mediation	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:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	TD F 62-03.4	Agreement to Extend Counseling to Participate in Mediation	Agreement to Extend Counseling with Mediation 62-03.4 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: 100 %

	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

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.