When resubmitted
for review, the agency shall assess, using concrete measures of
program effectiveness, the success of these reports in assuring
that a beneficiary's needs are being met (Form CM-623) and in
determining the capability of a beneficiary to manage monthly
benefits.
Inventory as of this Action
Requested
Previously Approved
06/30/1991
06/30/1991
2,750
0
0
3,813
0
0
0
0
0
REPRESENTATIVE PAYEE REPORT IS USED TO
ENSURE BENEFITS CERTIFIED AND PAID TO A REPRESENTATIVE ARE BEING
USED FOR THE BENEFICIARY'S WELL BEING. PHYSICIAN'S/MEDICAL
OFFICER'S STATEMENT IS USED TO DETERMINE THE BENEFICIARY'S
CAPABILITY TO MANAGE MONTHLY BLACK LUNG BENEFITS.
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.