Information Collection

Employee Claim for Wage Restitution

IC 182985 under ICR 202409-1600-001 · OMB 1600-0002.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHS 700-4 Employee Claim for Wage Restitution	Form
Form DHS 700-4 Employee Claim for Wage Restitution Employee Claim for Wage Restitution	Form
DHS 700-4 Employee Claim for Wage Restitution DHS Form 700-4.pdf	Form
DHS 700-4 Employee Claim for Wage Restitution DHS Form 700-4.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation:

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	DHS 700-4				Yes	No	Fillable Printable

Line of Business: Supply Chain Management

Subfunction: Services Acquisition

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 55

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	55	55
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].