Certification By School Official

ICR 200702-1215-005

OMB: 1215-0061

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
0000-00-00
IC Document Collections
IC ID
Document
Title
Status
13706 Modified
ICR Details
1215-0061 200702-1215-005
Historical Active 200403-1215-007
DOL/ESA
Certification By School Official
Extension without change of a currently approved collection   No
Regular
Approved without change 05/16/2007
Retrieve Notice of Action (NOA) 03/01/2007
  Inventory as of this Action Requested Previously Approved
05/31/2010 36 Months From Approved 05/31/2007
400 0 500
67 0 84
0 0 0

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.

US Code: 30 USC 901 Name of Law: Black Lung Benefits Act
  
None

Not associated with rulemaking

  71 FR 66350 11/14/2006
72 FR 9361 03/01/2007
No

1
IC Title Form No. Form Name
Certification By School Official CM-981 Certification By School Official

  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 400 500 0 0 -100 0
Annual Time Burden (Hours) 67 84 0 0 -17 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There is an adjustment to the number of students requiring verification. Because of the aging of the black lung population, there are fewer students age 18 and over who are attending school full-time. Since the number of forms represent approximately twice the number of students age 18 and over, with student status verified once each term, there is a corresponding reduction of forms and burden hours to the public. The number of respondents has decreased from 500 to 400. The number of burden hours has decreased from 84 hours to 67 hours, which resulted in an adjustment of -17 burden hours.

$2,316
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Michael McClaran 202-693-0978 mcclaran.michael@dol.gov

  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.
03/01/2007


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