Information Collection

Description of Coal Mine Work and Other Employment

IC 13691 under ICR 202003-1240-001 · OMB 1240-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0035 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CM-913 Description of Coal Mine Work and Other Employment	Form
CM-913 Description of Coal Mine Work and Other Employment 20200601 CM-913 1240-0035.docx dol.gov/owcp/regs/compliance/cm-913/pdf	Form

IC Title:

Description of Coal Mine Work and Other Employment

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 725.405b 20 CFR 718.204b1

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-913	Description of Coal Mine Work and Other Employment	20200601 CM-913 1240-0035.docx	http://dol.gov/owcp/regs/compliance/cm-913/pdf	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title: DOL/OWCP-2 and DOL/OWCP-9

FR Citation: 81 FR 25765

Number of Respondents: 6,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,100	4,450	1,650
Annual IC Time Burden (Hours)	3,050	1,950	1,100
Annual IC Cost Burden (Dollars)	3,515	2,657	858

Documents for IC

table that charts IC Documents
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.