This is approved
as per the changes made in the 11/18/03 supporting statement. Also,
ESA has successfully implemented an electronic submission
mechanism.
Inventory as of this Action
Requested
Previously Approved
11/30/2006
11/30/2006
11/30/2003
4,500
0
4,500
4,500
0
4,500
2,000
0
2,000
Information collected with this form
is used to evaluate the financial profile of OWCP beneficiaries who
have been overpaid benefits, and their ability to repay. OWCP
beneficiaries are typically retired coal miners disabled by black
lung disease, Federal employees injured on the job, and their
survivors.
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.