REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR

ICR 198408-0960-011

OMB: 0960-0322

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0322 198408-0960-011
Historical Active 198211-0960-012
SSA
REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR
Revision of a currently approved collection   No
Regular
Approved without change 09/24/1984
Retrieve Notice of Action (NOA) 08/30/1984
  Inventory as of this Action Requested Previously Approved
08/31/1987 08/31/1987 11/30/1984
8,000 0 8,000
1,008 0 1,333
0 0 0

THE INFORMATION COLLECTED BY THE USE OF FORM SSA-2613 IS NEEDED TO ASSURE CONTINUATION OF STUDENT'S BENEFITS TO AN ENTITLED CHILD OF THE MINER. THE AFFECTED PUBLIC IS COMPRISED OF INDIVIDUALS WHO WISH TO HAVE THEIR BLACK LUNG STUDENT'S BENEFITS CONTINUED.

None
None


No

1
IC Title Form No. Form Name
REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR SSA-2613

  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 8,000 8,000 0 0 0 0
Annual Time Burden (Hours) 1,008 1,333 0 -325 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
08/30/1984


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