REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR

ICR 198211-0960-012

OMB: 0960-0322

Federal Form Document

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ICR Details
0960-0322 198211-0960-012
Historical Active
SSA
REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 12/22/1982
Retrieve Notice of Action (NOA) 11/22/1982
  Inventory as of this Action Requested Previously Approved
11/30/1984 11/30/1984
8,000 0 0
1,333 0 0
0 0 0

SECTION 402(G) OF THE FEDERAL MINE SAFETY AND HEALTH ACT AND SECTION 205(A) OF THE SOCIAL SECURITY ACT PROVIDE FOR THE COLLECTION OF INFORMATION REGARDING SCHOOL ATTENDANCE TO ASSURE CONTINUATION OF STUDENTS' BENEFITS. THE INFORMATION COLLECTED ON FORMS SSA-2613 IS USED AS A CERTIFICATION BY BOTH STUDENT AND EDUCATIONAL INSTITUTION TH THE STUDENT IS IN FULL-TIME ATTENDANCE.

None
None


No

1
IC Title Form No. Form Name
REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR SSA-2613

  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 8,000 0 0 8,000 0 0
Annual Time Burden (Hours) 1,333 0 0 1,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
11/22/1982


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