Arbitrator's Personal Data Questionnaire (FMCS Form R-22)

Forms and Documents

Document Name	Status
Form Form R-22 Arbitrator's Personal Data Questionnaire Form and Instruction	Modified
6-25-2025 OMB Supporting Statement R-22 - OMB No. 3076-0001 R-22 Final.docx Supporting Statement A	2025-06-26

IC Document Collections

IC ID	Document Title	Status
32213	Arbitrator's Personal Data Questionnaire Form and Instruction	Modified

ICR Details

OMB Control No: 3076-0001	ICR Reference No: 202505-3076-002
Status: Received in OIRA	Previous ICR Reference No: 202202-3076-002
Agency/Subagency: FMCS	Agency Tracking No:
Title: Arbitrator's Personal Data Questionnaire (FMCS Form R-22)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/26/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	07/31/2025
Responses	50	50
Time Burden (Hours)	125	125
Cost Burden (Dollars)	0	0

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Abstract: This form provides for the operation and maintenance of a roster of professional arbitrators who are available to assist governmental and private sector organizations in resolving labor disputes. The Agency uses the information supplied in this form to evaluate the credentials of applicants and determine their suitability for inclusion on the roster.

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Authorizing Statute(s): US Code: 29 USC 171(b) Name of Law: Labor Management Relations Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 11541	03/07/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 21480	05/20/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Arbitrator's Personal Data Questionnaire	Form R-22	Arbitrator's Personal Data Questionnaire (Form R-22)

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	50	50	0	0	0	0
Annual Time Burden (Hours)	125	125	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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:

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Annual Cost to Federal Government: $19,330

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

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/26/2025

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