STATEMENT OF EMPLOYMENT AND FINANCIAL INTERESTS (FOR USE BY STATE EMPLOYEES)

ICR 198503-1029-002

OMB: 1029-0067

Federal Form Document

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Document
Name
Status
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ICR Details
1029-0067 198503-1029-002
Historical Active 198408-1029-002
DOI/OSMRE
STATEMENT OF EMPLOYMENT AND FINANCIAL INTERESTS (FOR USE BY STATE EMPLOYEES)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 05/29/1985
Retrieve Notice of Action (NOA) 03/05/1985
  Inventory as of this Action Requested Previously Approved
01/31/1988 01/31/1988
1,924 0 0
639 0 0
0 0 0

COLLECT EMPLOYMENT AND FINANCIAL INTERESTS INFORMATION ON STATE REGULATORY AUTHORITY EMPLOYEES UNDER SECTION 517(G), SURFACE MINING CONTROL AND RECLAMATION ACT OF 1977, P.L. 95-87, AS NO EMPLOYEE PERFORMING ANY FUNCTION OR DUTIES UNDER THE ACT SHALL HAVE A DIRECT OR INDIRECT FINANCIAL INTEREST IN ANY UNDERGROUND OR SURFACE COAL MINING OPERATION.

None
None


No

1
IC Title Form No. Form Name
STATEMENT OF EMPLOYMENT AND FINANCIAL INTERESTS (FOR USE BY STATE EMPLOYEES)

  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 1,924 0 0 0 1,924 0
Annual Time Burden (Hours) 639 0 0 0 639 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.
03/05/1985


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