Miner's Claim for Benefits Under the Black Lung Benefits Act and Employment History

ICR 200805-1215-006

OMB: 1215-0052

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
1215-0052 200805-1215-006
Historical Active 200506-1215-004
DOL/ESA
Miner's Claim for Benefits Under the Black Lung Benefits Act and Employment History
Extension without change of a currently approved collection   No
Regular
Approved without change 09/05/2008
Retrieve Notice of Action (NOA) 07/30/2008
  Inventory as of this Action Requested Previously Approved
09/30/2011 36 Months From Approved 09/30/2008
7,500 0 9,000
5,250 0 6,333
1,449 0 1,000

CM-911 is the standard application form filed by the miner for benefits under the Black Lung Benefits Act. The applicant lists the coal miner's work history on the CM-911a, and this form is completed by all applicants, both miners and survivors.

US Code: 30 USC 901 Name of Law: null
  
None

Not associated with rulemaking

  73 FR 23274 04/29/2008
73 FR 44281 07/30/2008
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 7,500 9,000 0 0 -1,500 0
Annual Time Burden (Hours) 5,250 6,333 0 0 -1,083 0
Annual Cost Burden (Dollars) 1,449 1,000 0 0 449 0
No
No
There is an adjustment reduction of respondents from 9,000 to 7,500 because there are fewer black lung applicants. The burden hour is an adjustment reduction from 6,333 to 5,250 which is a difference of -1,083 burden hours due to fewer applicants. There has been an increase to the operation and maintenance cost from $1,000 to $1,449 due to increase in postage.

$119,260
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Michael McClaran 202-693-0978 [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.
07/30/2008


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