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

ICR 198908-1029-002

OMB: 1029-0067

Federal Form Document

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Document
Name
Status
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ICR Details
1029-0067 198908-1029-002
Historical Active 198608-1029-001
DOI/OSMRE
STATEMENT OF EMPLOYMENT AND FINANCIAL INTERESTS (FOR USE BY STATE EMPLOYEES)
Extension without change of a currently approved collection   No
Regular
Approved without change 10/23/1989
Retrieve Notice of Action (NOA) 08/11/1989
  Inventory as of this Action Requested Previously Approved
06/30/1990 06/30/1990 10/31/1989
1,989 0 1,989
667 0 667
0 0 0

, 'SURFACE MINING'. RESPONDENTS SUPPLY INFORMATION ON EMPLOYMENT AND FINANCIAL INTERESTS. THE INFORMATION IS USED TO DETERMINE IF RESPONDENTS ARE IN COMPLIANCE WITH SECTION 517(G) OF THE SURFACE MIING CONTROL AND RECLAMATION ACT OF 1977 WHICH PLACES AN ABSOLUTE PROHIBITION ON HAVING A DIRECT OR INDIRECT FINANCIAL INTEREST IN UNDERGROUND OR SURFACE COAL MINING OPERATIONS.

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 1,989 1,989 0 0 0 0
Annual Time Burden (Hours) 667 667 0 0 0 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.
08/11/1989


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