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Report of Changes That May Affect Your Black Lung Benefits

IC 13756 under ICR 200709-1215-002 · OMB 1215-0084.

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Report of Changes That May Affect Your Black Lung Benefits
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.513

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-929 Report of Changes That May Affect Your Black Lung Benefits CM-929 4-2-2008.doc http://www.dol.gov/esa/regs/compliance/owcp/cm-929.pdf Yes No Fillable Printable
Form and Instruction CM-929P Report of Changes That May Affect Your Black Lung Benefits CM-929P 4-10-2008.doc http://www.dol.gov/libraryforms/FormsByNum.asp Yes No Fillable Printable

Income Security General Retirement and Disability

DOL/ESA-6  67 FR 16869

70,000 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 70,000 0 19,000 0 0 51,000
Annual IC Time Burden (Hours) 15,269 0 10,764 0 0 4,505
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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