Certification by School Official

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CM-981 Certification by School Official	Form	Modified	Available
Supporting Statement 1240-0031 2026 3 11.docx	Supporting Statement A	Uploaded 2026-03-11	Available
30 USC 901-945.pdf	Supplementary Document	Uploaded 2019-10-09	Available
System of Record Notice-DOL OWCP-2.pdf	Supplementary Document	Uploaded 2019-10-09	Available
725.209 to 725.218.pdf	Supplementary Document	Uploaded 2019-10-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13706	Certification By School Official	Form	Modified	Certification by School Official
13706	Certification By School Official	Form	Modified

ICR Details

OMB Control No: 1240-0031	ICR Reference No: 202601-1240-004
Status: Received in OIRA	Previous ICR Reference No: 202401-1240-004
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Certification by School Official
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 03/11/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	195	93
Time Burden (Hours)	33	16
Cost Burden (Dollars)	146	53

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Abstract: The Office of Workers Compensation Programs Form 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.

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Authorizing Statute(s): US Code: 30 USC 901-944 Name of Law: Black Lung Benefits Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 61421	12/31/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 11991	03/11/2026
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

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

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	195	93	0	0	102	0
Annual Time Burden (Hours)	33	16	0	0	17	0
Annual Cost Burden (Dollars)	146	53	0	0	93	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Respondents: The number of respondents increased from 93 to 195. The following also increased due to an increased number of forms received/responses. Responses: Responses have increased from 93 to 195 due to the increase in respondents. Burden Hours: Burden hours have increased from 16 to 33 also due to the increase in respondents. Costs to Respondents: Burden costs to respondents increased from $53.00 to $146.00 due to an increase in postage.

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Annual Cost to Federal Government: $1,779

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/11/2026

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