Information Collection

Arbitrator's Report and Fee Statement

IC 32221 under ICR 202505-3076-003 · OMB 3076-0003.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Form R-19 Arbitrator's Report and Fee Statement	Form and Instruction
Form Form R-19 Arbitrator's Report and Fee Statement Arbitrator's Report and Fee Statement	Form and Instruction
Form R-19 Arbitrator's Report and Fee Statement Form R-19 - OMB No. 3076-0003.pdf www.fmcs.gov/services/arbitration/information-fmcs-roster-arbitrators/	Form and Instruction
Form R-19 Arbitrator's Report and Fee Statement Form R-19 - OMB No. 3076-0003.pdf www.fmcs.gov/services/arbitration/information-fmcs-roster-arbitrators/	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: 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 and Instruction	Form R-19			https://www.fmcs.gov/services/arbitration/information-fmcs-roster-arbitrators/	Yes	Yes	Fillable Fileable

Line of Business: Litigation and Judicial Activities

Subfunction: Resolution Facilitation

Privacy Act System of Records

Title: Arbitration SORN

FR Citation: 87 FR 16737

Number of Respondents: 2,000

Number of Respondents for Small Entity: 1,500

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	333	333
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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