Information Collection

Report Of Changes That May Affect Your Department Of Labor Black Lung Payment

IC 122104 under ICR 198302-1215-001 · OMB 1215-0084.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1215-0084 can be found here:

Documents and Forms

Document Name Document Type

No indexed documents/forms are available for this IC yet. A refresh has been queued.

Information Collection (IC) Details

View Information Collection (IC)

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

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ESA/BL				No	No
Form	CM-929				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 93,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	93,000	-97,000	190,000
Annual IC Time Burden (Hours)	12,090	-19,576	31,666
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

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