Survivor's Form for Benefits Under the Black Lung Benefits Act

Survivor's Form for Benefits Under the Black Lung Benefits Act

OMB: 1240-0027

IC ID: 13721

Information Collection (IC) Details

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Survivor's Form for Benefits Under the Black Lung Benefits Act
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.304

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-912 Survivor's For for Benefits Under the Black Lung Benefits Act 20200323 CM912.docx http://dol.gov/owcp/regs/compliance/cm-912 Yes No Fillable Printable

Income Security Survivor Compensation

DOL/OWCP-2 and DOL/OWCP-9  67 FR 16869

850 0
   
Individuals or Households
 
   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 850 0 -250 0 0 1,100
Annual IC Time Burden (Hours) 113 0 -34 0 0 147
Annual IC Cost Burden (Dollars) 377 0 -73 0 0 450

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