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OMB Control No: 1240-0031	ICR Reference No: 202601-1240-004
Status: Received in OIRA	Previous ICR Reference No: 202401-1240-004
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	Date Submitted to OIRA: 03/11/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	06/30/2026
Responses	195	93
Time Burden (Hours)	33	16
Cost Burden (Dollars)	146	53

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	195	93	102
Annual Time Burden (Hours)	33	16	17
Annual Cost Burden (Dollars)	146	53	93

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: No

Burden Reduction Due to:

Short Statement: Respondents: The number of respondents increased from 93 to 195. The following also increased due to an increased number of forms received/responses. Responses: Responses have increased from 93 to 195 due to the increase in respondents. Burden Hours: Burden hours have increased from 16 to 33 also due to the increase in respondents. Costs to Respondents: Burden costs to respondents increased from $53.00 to $146.00 due to an increase in postage.

Annual Cost to Federal Government: $1,779

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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