Information Collection

Black Lung Clinic Program And Program Guidelines -- 42 Cfr 55a

IC 110256 under ICR 199402-0915-001 · OMB 0915-0081.

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IC Title:	BLACK LUNG CLINIC PROGRAM AND PROGRAM GUIDELINES -- 42 CFR 55A	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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	14	0	14
Annual IC Time Burden (Hours)	42,000	15,417	26,583
Annual IC Cost Burden (Dollars)	0	0	0

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