BLACK LUNG STUDENT'S STATEMENT REGARDING RESUMPTION OF SCHOOL ATTENDANCE, SSA-2602, REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR, SSA-2613
ICR 199309-0960-001
OMB: 0960-0314
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0960-0314 can be found here:
BLACK LUNG STUDENT'S
STATEMENT REGARDING RESUMPTION OF SCHOOL ATTENDANCE, SSA-2602,
REPORT OF BLACK LUNG STUDENT BENEFICIARY AT END OF SCHOOL YEAR,
SSA-2613
THE INFORMATION COLLECTED BY FORMS
SSA-2602 AND 2613 IS NEEDED TO DETERMINE WHETHER OR NOT A STUDENT
BENEFICIARY WILL RESUME FULL-TIME SCHOOL ATTENDANCE AFTER THE END
OF THE REGULAR SCHOOL YEAR AND BE ENTITLED TO ADDITIONAL BENEFITS.
THE AFFECTED PUBLIC IS COMPRISED OF STUDENTS WHO ARE CHILDREN OF
DECEASED OR DISABLED COAL MINERS AND OFFICIALS OF THE SCHOOLS THEY
ATTEND.
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.