REPORT OF CHANGES THAT MAY AFFECT YOUR DEPARTMENT OF LABOR BLACK LUNG PAYMENT

ICR 198302-1215-001

OMB: 1215-0084

Federal Form Document

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ICR Details
1215-0084 198302-1215-001
Historical Active 198107-1215-010
DOL/ESA
REPORT OF CHANGES THAT MAY AFFECT YOUR DEPARTMENT OF LABOR BLACK LUNG PAYMENT
Revision of a currently approved collection   No
Regular
Approved without change 02/14/1983
Retrieve Notice of Action (NOA) 02/03/1983
  Inventory as of this Action Requested Previously Approved
07/31/1985 07/31/1985 07/31/1984
93,000 0 190,000
12,090 0 31,666
0 0 0

TO DETERMINE WHETHER OR NOT CERTAIN CHANGES HAVE OCCURRED THAT MAY AFFECT THE PRIMARY BENEFICIARY'S MONTHLY BENEFIT AMOUNT. THE FORM SERVES AS AN ANNUAL UPDATE OF CERTAIN PERTINENT INFORMATION. SAME OR A DIFFERENT LEVEL OF BENEFITS (20 CFR 725.538)

None
None


No

1
IC Title Form No. Form Name
REPORT OF CHANGES THAT MAY AFFECT YOUR DEPARTMENT OF LABOR BLACK LUNG PAYMENT ESA/BL, CM-929

  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 93,000 190,000 0 0 -97,000 0
Annual Time Burden (Hours) 12,090 31,666 0 0 -19,576 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
02/03/1983


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