Information Collection

Agreement to Mediate

IC 19490 under ICR 200910-1545-006 · OMB 1545-1844.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1545-1844 can be found here:

Documents and Forms

Document Name Document Type
Form 13369 Agreement to Mediate Form
13369 Agreement to Mediate Form 13369.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Agreement to Mediate	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	13369	Agreement to Mediate	Form 13369.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Taxation Management

Privacy Act System of Records
Title: Agreement to Mediate	FR Citation: 71 FR 29392

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.