CERTIFICATION OF CONTINUING ENTITLEMENT TO BENEFITS

ICR 197709-1215-004

OMB: 1215-0084

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
122102 Migrated
ICR Details
1215-0084 197709-1215-004
Historical Active
DOL/ESA
CERTIFICATION OF CONTINUING ENTITLEMENT TO BENEFITS
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/16/1977
Retrieve Notice of Action (NOA) 09/14/1977
  Inventory as of this Action Requested Previously Approved
05/31/1982 05/31/1982
2,900 0 0
483 0 0
0 0 0

REPORT IS USED TO DETERMINE WHETHER THE FACTS AND CIRCUMSTANCES UNDER WHICH THE CLAIMANT WAS FOUND ENTITLED TO AND AWARD BENEFITS HAVE CHANGED AND WHETHER THE CLAIMANT IS STILL ENTITLED TO THE SAME OR A DIFFERENT LEVEL OF BENEFITS (20 CFR 725.538)

None
None


No

1
IC Title Form No. Form Name
CERTIFICATION OF CONTINUING ENTITLEMENT TO BENEFITS CM-929

  Total Approved 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 2,900 0 0 0 2,900 0
Annual Time Burden (Hours) 483 0 0 0 483 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/14/1977


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