Information Collection

Representative Fee Request

IC 13744 under ICR 202503-1240-001 · OMB 1240-0049.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CA-143 and CA-155 Representative Fee Request	Form and Instruction
Form CA-143 and CA-155 Attorney Fee Request Representative Fee Request	Form and Instruction
CA-143 and CA-155 Attorney Fee Request CA-143 CA-155 with proposed changes.docx ecomp.dol.gov	Form and Instruction
CA-143 and CA-155 Attorney Fee Request CA-143 CA-155 with proposed changes.docx ecomp.dol.gov	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 10.700-703

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 and Instruction	CA-143 and CA-155			ecomp.dol.gov	No		Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/GOVT-1

FR Citation: 81 FR 47418

Number of Respondents: 6,328

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,328	2,293	4,035
Annual IC Time Burden (Hours)	3,164	1,146	2,018
Annual IC Cost Burden (Dollars)	1,107,400	1,106,415	985

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.

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