Coal Mine Operator Response to Schedule for Submission of Additional Evidence and Operator Response to Notice of Claim

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CM-2970a Operator Response to Notice of Claim	Form	Modified	Repair queued
Form CM-2970 Operator Response to Schedule for Submission of Additional Evidence	Form	Modified	Available
FRN Notice for SORN.pdf	Supplementary Document	Uploaded 2017-03-13	Available
2017 Supporting Statement 1240-0033 CM-2970 and CM-2970a.doc	Supporting Statement A	Uploaded 2017-03-21	Repair queued
20CFR725.407-408.pdf	Supplementary Document	Uploaded 2007-08-08	Available
20CFR725.412.pdf	Supplementary Document	Uploaded 2007-08-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
13697	Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim	Form	Modified	Operator Response to Notice of Claim
13697	Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim	Form	Modified	Operator Response to Schedule for Submission of Additional Evidence

ICR Details

OMB Control No: 1240-0033	ICR Reference No: 201611-1240-002
Status: Historical Active	Previous ICR Reference No: 201309-1240-004
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Coal Mine Operator Response to Schedule for Submission of Additional Evidence and Operator Response to Notice of Claim
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/16/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/22/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2017
Responses	9,600	0	9,600
Time Burden (Hours)	2,000	0	2,000
Cost Burden (Dollars)	4,800	0	4,704

---

Abstract: The OWCP, Division of Coal Mine Workers' Compensation (DCMWC) administers the Black Lung Benefits Act (30 U.S.C. 901 et seq.), which provides benefits to coal miners totally disabled due to pneumoconiosis and their surviving dependents. When the DCMWC makes a preliminary analysis of a claimant's eligibility for benefits, and if a coal mine operator has been identified as potentially liable for payment of those benefits, the responsible operator is notified of the preliminary analysis. Regulations codified at 20 CFR part 725 require that a coal mine operator be identified and notified of potential liability as early in the adjudication process as possible. Coal Mine Operator Response to Schedule for Submission of Additional Evidence (Form CM-2970) and Operator Response to Notice of Claim (Form CM-2970a) are used for claims filed after January 19, 2001, and indicate that the coal mine operator will submit additional evidence or respond to the notice of claim.

---

Authorizing Statute(s): US Code: 30 USC 901 Name of Law: Black Lung Benefits Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 78863	11/09/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 14751	03/22/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim	CM-2970a, CM-2970	Operator Response to Schedule for Submission of Additional Evidence ,   Operator Response to Notice of Claim

---

ICR Summary of Burden

table that charts list of burden

	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	9,600	9,600	0	0	0	0
Annual Time Burden (Hours)	2,000	2,000	0	0	0	0
Annual Cost Burden (Dollars)	4,800	4,704	0	0	96	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $34,744

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 03/22/2017

---