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

ICR 200901-1215-001

OMB: 1215-0064

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
1215-0064 200901-1215-001
Historical Active 200606-1215-002
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 06/15/2009
Retrieve Notice of Action (NOA) 05/18/2009
  Inventory as of this Action Requested Previously Approved
06/30/2012 36 Months From Approved 08/31/2009
7,000 0 7,500
1,400 0 1,500
6,300 0 6,000

Coal mine operators who pay monthly benefits must notify the Department’s Division of Coal Mine Workers’ Compensation (DCMWC) of any change in payments and the reason for that change. DCMWC uses this notification to monitor payments and ensure that beneficiaries receive the correct benefit rate.

None
None

Not associated with rulemaking

  74 FR 7620 02/18/2009
74 FR 23207 05/18/2009
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 7,000 7,500 0 0 -500 0
Annual Time Burden (Hours) 1,400 1,500 0 0 -100 0
Annual Cost Burden (Dollars) 6,300 6,000 0 0 300 0
No
No
The burden of this ICR is decreased because of a adjustment due to fewer annual Form CM-908 filings. See Item 15 of the Supporting Statement.

$55,875
No
No
Uncollected
Uncollected
No
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.
05/18/2009


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