Information Collection

Certification By School Official

IC 13706 under ICR 201302-1240-002 · OMB 1240-0031.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0031 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CM-981 Certification by School Official Certification By School Official	Form
CM-981 Certification by School Official CM-981.pdf www.dol.gov/owcp/regs/compliance/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:

Certification By School Official

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 725.209

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			http://www.dol.gov/owcp/regs/compliance/cm-981.pdf	Yes	No	Fillable Printable

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: 493

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	493	193	300
Annual IC Time Burden (Hours)	82	32	50
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.

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