View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 3060-1258	ICR Reference No: 202107-3060-005
Status: Historical Active	Previous ICR Reference No: 201808-3060-002
Agency/Subagency: FCC	Agency Tracking No: OWD
Title: Alternative Dispute Resolution Form Requests, FCC Form 5628
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/20/2021
	Date Received in OIRA: 07/20/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2024	36 Months From Approved	10/31/2021
Responses	7	0	5
Time Burden (Hours)	25	0	18
Cost Burden (Dollars)	10,000	0	3,750

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	7	5	2
Annual Time Burden (Hours)	25	18	7
Annual Cost Burden (Dollars)	10,000	3,750	6,250

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Commission is reporting adjustments to this information collection. The total number of respondents increased by +2, the total annual responses increased by +2, the total annual burden hours increased by +7 hours and the total annual costs increased by +$6,250. These calculations are based on the most currently available data to the Commission.

Annual Cost to Federal Government: $28,391

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Cynthia Bryant 202 418-8165 cynthia.bryant@fcc.gov

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.