Information Collection

Certification By School Official

IC 13706 under ICR 202601-1240-004 · OMB 1240-0031.

Documents and Forms

Document Name Document Type
Form CM-981 Certification by School Official Certification By School Official Form
CM-981 Certification by School Official cm-981-Form.pdf www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
30 USC 901-902.pdf 30USC901 - 902 IC Document
725.209 to 725.218.pdf OWCP-2 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Certification By School Official	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 725.209-218

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-981	Certification by School Official	cm-981-Form.pdf	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: Privacy Act System of Records, DOL/OWCP-2	FR Citation: 67 FR 16869

Number of Respondents: 195	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 10 %

	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	195	102	93
Annual IC Time Burden (Hours)	33	17	16
Annual IC Cost Burden (Dollars)	146	93	53

Documents for IC

Title	Document	Date Uploaded
30USC901 - 902	30 USC 901-902.pdf	02/07/2007
OWCP-2	725.209 to 725.218.pdf	09/09/2019

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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