MAINTENANCE OF RECEIPTS FOR BENEFITS PAID BY A COAL MINE OPERATOR (RECORD KEEPING REQUIREMENT)

ICR 199208-1215-003

OMB: 1215-0124

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
ICR Details
1215-0124 199208-1215-003
Historical Active 198909-1215-002
DOL/ESA
MAINTENANCE OF RECEIPTS FOR BENEFITS PAID BY A COAL MINE OPERATOR (RECORD KEEPING REQUIREMENT)
Revision of a currently approved collection   No
Regular
Approved without change 10/08/1992
Retrieve Notice of Action (NOA) 08/17/1992
  Inventory as of this Action Requested Previously Approved
10/31/1995 10/31/1995 11/30/1992
150 0 185
1 0 1
0 0 0

CFR 725.531 REQUIRES SELF-INSURED OPERATORS OR INSURANCE CARRIERS WHO MAKE BENEFIT PAYMENTS TO BLACK LUNG BENEFICIARIES TO MAINTAIN RECEIPTS FOR THOSE PAYMENTS FOR 5 YEARS. CANCELLED CHECKS WILL SUFFICE.

None
None


No

1
IC Title Form No. Form Name
MAINTENANCE OF RECEIPTS FOR BENEFITS PAID BY A COAL MINE OPERATOR (RECORD KEEPING REQUIREMENT) CM-200

  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 150 185 0 -35 0 0
Annual Time Burden (Hours) 1 1 0 0 0 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.
08/17/1992


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