Prior to
printing, DOL will update the OMB expiration date on this form to
three years from its most recent approval date.
Inventory as of this Action
Requested
Previously Approved
12/31/2004
12/31/2004
10/31/2001
224
0
224
896
0
896
0
0
0
Data are used to monitor the impact of
disqualification provisions to measure workload and to appraise the
adequacy and effectiveness of State and Federal nonmonetary
determination procedures.
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.