Black Lung Clinics Program Database

Forms and Documents

Document Name	Status
Form BLCP 2007 Black Lung Clinics Program Database Form and Instruction	Modified
ss 0292.doc Supporting Statement A	2007-09-06

IC Document Collections

IC ID	Document Title	Status
6545	Black Lung Clinics Program Database Form and Instruction	Modified

ICR Details

OMB Control No: 0915-0292	ICR Reference No: 200709-0915-001
Status: Historical Active	Previous ICR Reference No: 200406-0915-002
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Black Lung Clinics Program Database
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/13/2007
	Date Received in OIRA: 09/10/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2010	36 Months From Approved	11/30/2007
Responses	15	0	15
Time Burden (Hours)	300	0	150
Cost Burden (Dollars)	0	0	0

---

Abstract: The Black Lung Clinics Program was designed to improve the health status of coal workers by providing services to minimize the effects of respiratory and pulmonary impairments of coal miners. The Black Lung Program Database is the reporting system for the Black Lung Clinic Program grantees.

---

Authorizing Statute(s): PL: Pub.L. 95 - 239 20 Name of Law: Black Lung Benefits Reform Act of 1977
   US Code: 30 USC 901 Name of Law: Black Lungs Benefits Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 10225	03/07/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 46638	08/21/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Black Lung Clinics Program Database	BLCP 2007, BLCP 2008 2009	BLCP 2007 ,   BLCP 2008 2009

---

ICR Summary of Burden

	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	15	15	0	0	0	0
Annual Time Burden (Hours)	300	150	0	150	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The Black Lung Clinics Program Database is revising the data collection tool to include new measures to address the program's OMB PART review. These new measures result in an increase in the burden, a program change of 150 additional hours.

---

Annual Cost to Federal Government: $1,588

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/10/2007

---