Information Collection

Federal Black Lung Benefits Verification (ro Monthly, Ro Mbo, And Tf Mbo)

IC 122380 under ICR 199211-1215-003 · OMB 1215-0179.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

FEDERAL BLACK LUNG BENEFITS VERIFICATION (RO MONTHLY, RO MBO, AND TF MBO)

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-999A, B				No	No
Form	C				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 42,300

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	42,300	42,300
Annual IC Time Burden (Hours)	2,509	2,509
Annual IC Cost Burden (Dollars)	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.