We have approved
these three information collection activities for two years for the
following reason: DOL has not yet assessed the effectiveness of
form CM-623 using concrete measures, as OMB directed in the
previous terms of clearance. ESA explains that the form has no yet
asked payees to complete and return the form, so the agency has no
been able to make such measurements.
Inventory as of this Action
Requested
Previously Approved
10/31/1993
10/31/1993
09/30/1991
2,750
0
2,750
2,250
0
3,813
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.