Information Collection

Agreement to Extend Counseling to Participate in Mediation

IC 230730 under ICR 202504-1505-001 · OMB 1505-0262.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form TD F 62-03.4 Agreement to Extend Counseling to Participate in Mediation	Form and Instruction
Form TD F 62-03.4 Agreement to Extend Counseling to Participate in Mediation 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 04 2025.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 04 2025.pdf	Form and Instruction

IC Title:

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 and Instruction	TD F 62-03.4				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 %

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.

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