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View ICR - OIRA Conclusion

OMB Control No: 1240-0031	ICR Reference No: 202304-1240-009
Status: Historical Active	Previous ICR Reference No: 202008-1240-044
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Certification by School Official
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/27/2023
	Date Received in OIRA: 05/23/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved	07/31/2023
Responses	93	0	100
Time Burden (Hours)	16	0	17
Cost Burden (Dollars)	53	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	93	100	-7
Annual Time Burden (Hours)	16	17	-1
Annual Cost Burden (Dollars)	53	0	53

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: EXPLANATION OF CHANGE TOTALS Respondents: The number of respondents decreased from 100 to 93. The number of respondents decreased due to a decreased of eligible dependents attending school. The following also decreased due to a decreased in number of forms received/responses. Responses: Responses have decreased from 100 to 93. Burden Hours: Burden hours have decreased from 17 to 16. The following Increased due to program changes in mailing cost. The Black Lung program does no longer provide pre-paid envelops to the beneficiaries to submit their responses. Costs: Annual burden costs have increased from $0.0 to $53.00.

Annual Cost to Federal Government: $743

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Marcela Meneses 304 420-1232 meneses.marcela@dol.gov

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