Certification By School Official

ICR 201005-1240-002

OMB: 1240-0031

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2010-05-25
Supplementary Document
2010-05-11
Supplementary Document
2010-05-11
Supplementary Document
2010-05-11
IC Document Collections
IC ID
Document
Title
Status
13706 Modified
ICR Details
1240-0031 201005-1240-002
Historical Active 201003-1240-031
DOL/OWCP
Certification By School Official
Extension without change of a currently approved collection   No
Regular
Approved without change 07/21/2010
Retrieve Notice of Action (NOA) 05/28/2010
  Inventory as of this Action Requested Previously Approved
07/31/2013 36 Months From Approved 07/31/2010
300 0 400
50 0 67
0 0 0

CM-981 is completed by a school official to verify whether a Black Lung beneficiary's dependent, aged 18 to 23, qualifies as a full-time student.

US Code: 30 USC 901 Name of Law: Black Lung Benefits Act
  
None

Not associated with rulemaking

  75 FR 4585 01/28/2010
75 FR 60062 05/28/2010
No

1
IC Title Form No. Form Name
Certification By School Official CM-981 Certification by School Official

  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 300 400 0 0 -100 0
Annual Time Burden (Hours) 50 67 0 0 -17 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$1,942
No
No
No
Uncollected
No
Uncollected
Michael McClaran 202-693-0978 [email protected]

  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.
05/28/2010


© 2024 OMB.report | Privacy Policy