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Report of Changes That May Affect Your Black Lung Benefits
Report of Changes That May Affect Your Black Lung Benefits
OMB: 1240-0028
IC ID: 13756
OMB.report
DOL/OWCP
OMB 1240-0028
ICR 201105-1240-005
IC 13756
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0028 can be found here:
2024-07-17 - No material or nonsubstantive change to a currently approved collection
2024-03-29 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form CM-929P
Report of Changes That May Affect Your Black Lung Benefits
Form and Instruction
CM-929 Report of Changes That May Affect Your Black Lung Benefi
CM-929.pdf
www.dol.gov/owcp/regs/compliance/cm-929.pdf
Form and Instruction
CM-929P Report of Changes That May Affect Your Black Lung Benefi
CM-929P.pdf
www.dol.gov/owcp/regs/compliance/cm-929P.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Report of Changes That May Affect Your Black Lung Benefits
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
20 CFR 725.513
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
CM-929P
Report of Changes That May Affect Your Black Lung Benefits
CM-929P.pdf
http://www.dol.gov/owcp/regs/compliance/cm-929P.pdf
Yes
No
Fillable Printable
Form and Instruction
CM-929
Report of Changes That May Affect Your Black Lung Benefits
CM-929.pdf
http://www.dol.gov/owcp/regs/compliance/cm-929.pdf
Yes
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Income Security
Subfunction:
General Retirement and Disability
Privacy Act System of Records
Title:
DOL/ESA-6
FR Citation:
67 FR 16869
Number of Respondents:
55,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
55,000
0
0
-15,000
0
70,000
Annual IC Time Burden (Hours)
12,627
0
0
-2,642
0
15,269
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.