Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments

ICR 200606-1215-002

OMB: 1215-0064

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
1215-0064 200606-1215-002
Historical Active 200306-1215-003
DOL/ESA
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments
Extension without change of a currently approved collection   No
Regular
Approved without change 08/28/2006
Retrieve Notice of Action (NOA) 06/15/2006
  Inventory as of this Action Requested Previously Approved
08/31/2009 36 Months From Approved 08/31/2006
7,500 0 9,000
1,500 0 1,800
6,000 0 3,000

Coal mine operators who pay monthly benefits must notify DCMWC of any change in payments and the reason for that change. DCMWC uses this notice to monitor payments to beneficiaries.

None
None


No

1
IC Title Form No. Form Name
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments CM-908

  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 7,500 9,000 0 0 -1,500 0
Annual Time Burden (Hours) 1,500 1,800 0 0 -300 0
Annual Cost Burden (Dollars) 6,000 3,000 0 0 3,000 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.
06/15/2006


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