Approved for use
through 9-93 under the following condition: Reevaluate the utility
of questions seven and eight. As these items can not be verified,
their contribution to the form is questionable.
Inventory as of this Action
Requested
Previously Approved
09/30/1993
09/30/1993
11/30/1990
30,000
0
30,000
15,000
0
15,000
0
0
0
THE INFORMATION COLLECTED ON THIS FORM
IS USED TO PROVE OR DISAPPROVE THE EXISTENCE OF A VALID COMMON-LAW
MARRIAGE. THE FORM COMPLETED BY AN INDIVIDUAL WHO ALLEGES A
COMMON-LAW MARRIAGE TO SOMEON ENTITLED TO SOCIAL SECURITY
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.