Claim adjudication process for alleged presence of pneumoconiosis

ICR 200802-1215-002

OMB: 1215-0090

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2008-04-22
Supplementary Document
2008-02-10
Supplementary Document
2008-02-10
Supplementary Document
2008-02-10
Supplementary Document
2008-06-11
Supplementary Document
2008-06-23
Supplementary Document
2008-08-06
Supplementary Document
2008-02-10
ICR Details
1215-0090 200802-1215-002
Historical Active 200502-1215-003
DOL/ESA
Claim adjudication process for alleged presence of pneumoconiosis
Extension without change of a currently approved collection   No
Regular
Approved with change 08/29/2008
Retrieve Notice of Action (NOA) 04/25/2008
By the next submission, DOL will explore amending the blood gas tables in 20 CFR 718 to change the chart's reference from "Above 50" to "Above 49".
  Inventory as of this Action Requested Previously Approved
08/31/2011 36 Months From Approved 08/31/2008
17,500 0 17,500
4,259 0 4,259
0 0 0

20 CFR 718 specifies that certain information relative to the medical condition of a claimant who is alleging the presence of pneumoconiosis be obtained as a routine function of the claim adjudication process. The medical specifications in the regulations have been formatted in a variety of forms to promote efficiency and accuracy in gathering the required data. These forms were designed to meet the need to gather medical evidence.

US Code: 30 USC 901 Name of Law: Federal Coal Mine Health & Safety Act
  
None

Not associated with rulemaking

  73 FR 5592 01/30/2008
73 FR 22432 04/25/2008
No

  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 17,500 17,500 0 0 0 0
Annual Time Burden (Hours) 4,259 4,259 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$2,112,038
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Steven Andoseh 202 693-0373 [email protected]

  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.
04/25/2008


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