Information Collection

Certification By School Official

IC 13706 under ICR 200702-1215-005 · OMB 1215-0061.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CM-981 Certification By School Official	Form
CM-981 Certification By School Official cm-981.pdf www.dol.gov/esa/regs/compliance/owcp/cm-981.pdf	Form
DOL-ESA 6.doc DOL-ESA 6	IC Document
30 USC 901-902.pdf 30USC901 - 902	IC Document
725.208 - .209.pdf 20CFR725.208 - 209	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 725.208

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-981	Certification By School Official	cm-981.pdf	http://www.dol.gov/esa/regs/compliance/owcp/cm-981.pdf	Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/ESA-6

FR Citation: 67 FR 16869

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	400	-100	500
Annual IC Time Burden (Hours)	67	-17	84
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.