Information Collection

Miners' Claim For Benefits And Reimbursement

IC 121951 under ICR 197912-1215-002 · OMB 1215-0052.

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Documents and Forms

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Document Name	Document Type

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IC Title:

MINERS' CLAIM FOR BENEFITS AND REIMBURSEMENT

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	CM-911A,	No	No
Form	& CM-915	No	No
Form	CM-911,	No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 190,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	510,000	400,000	110,000
Annual IC Time Burden (Hours)	140,000	66,667	73,333
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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