Certification by School Official

ICR 201909-1240-001

OMB: 1240-0031

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2020-02-28
Justification for No Material/Nonsubstantive Change
2020-02-28
Supporting Statement A
2020-07-14
Supplementary Document
2019-10-09
Supplementary Document
2019-10-09
Supplementary Document
2019-10-09
IC Document Collections
IC ID
Document
Title
Status
13706 Modified
ICR Details
1240-0031 201909-1240-001
Historical Active 201601-1240-012
DOL/OWCP
Certification by School Official
Reinstatement without change of a previously approved collection   No
Regular
Approved with change 07/15/2020
Retrieve Notice of Action (NOA) 02/04/2020
  Inventory as of this Action Requested Previously Approved
07/31/2023 36 Months From Approved
100 0 0
17 0 0
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 901-944 Name of Law: Black Lung Benefits Act
  
None

Not associated with rulemaking

  84 FR 64567 11/22/2019
85 FR 5995 02/03/2020
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 100 0 0 0 -393 493
Annual Time Burden (Hours) 17 0 0 0 -65 82
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The estimated number of completed collections of information is reduced to 100, from 493. Likewise the respondent burden hours are reduced to 17 from 82. There are fewer eligible dependents attending school full-time.

$825
No
    No
    Yes
No
No
No
No
Anjanette Suggs 202 354-9660 [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.
02/04/2020


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