Information Collection

Request for Arbitration Panel, FMCS Form R-43

IC 220241 under ICR 202207-3076-003 · OMB 3076-0016.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3076-0016 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form R-43 Request for Arbitration Panel, FMCS Form R-43	Form
R-43 Request for Arbitration Panel R43 - Final.pdf	Form
R-43 Request for Arbitration Panel R43 - Final.pdf	Form

IC Title:

Request for Arbitration Panel, FMCS Form R-43

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-43	Request for Arbitration Panel	R43 - Final.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records

Title: Arbitration Records SORN

FR Citation: 87 FR 16737

Number of Respondents: 6,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,000	-10,000	16,000
Annual IC Time Burden (Hours)	1,000	-1,667	2,667
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.