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Federal forms, ICRs, and supporting documents

Information Collection

Application for Benefits Under The Federal Mine Safety and Dependent's Claim

IC 37953 under ICR 200109-0960-025 · OMB 0960-0118.

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Information Collection (IC) Details

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Application for Benefits Under The Federal Mine Safety and and Dependent's Claim
 
No Migrated
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form SSA-49-F3 No No
Form SSA-48-F4 No No
Form SSA-47-F4 No No


    

300 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 300 0 0 -1,500 0 1,800
Annual IC Time Burden (Hours) 165 0 0 -165 0 330
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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