Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor

Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor

OMB: 1240-0011

IC ID: 13877

Information Collection (IC) Details

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Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.366 20 CFR 725.365

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-972 Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by the U.S. Department of Labor cm-972_working.pdf http://www.dol.gov/owcp/regs/compliance/cm-972.pdf Yes No Fillable Printable

Income Security Survivor Compensation

DOL/ESA-6  67 FR 16869

338 276
   
Private Sector Businesses or other for-profits
 
   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 338 0 0 53 0 285
Annual IC Time Burden (Hours) 237 0 0 37 0 200
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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