Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CM-908 Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments	Form	Modified	Available
1240-0030 Notice of Termination Suspension Reduction or Increase in Benefits (CM-908).pdf	Supplementary Document	Uploaded 2020-08-27	Available
Justification - Notification of Termination Suspension Reduction or Increase in Benefit Payments (CM-908).docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-08-25	Available
Justifiction - CM-908.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2020-02-20	Available
CM-908 Notification of Termination, Suspension, Reduction, or Increase in Benefit Payments.pdf	Supplementary Document	Uploaded 2020-02-20	Available
System of Record Notice-DOL OWCP-2.pdf	Supplementary Document	Uploaded 2018-07-31	Available
SS 1240-0030 (CM-908) 2018.doc	Supporting Statement A	Uploaded 2018-08-30	Available
20 CFR 725.621.pdf	Supplementary Document	Uploaded 2009-01-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
43806	Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments	Form	Modified

ICR Details

OMB Control No: 1240-0030	ICR Reference No: 202008-1240-043
Status: Active	Previous ICR Reference No: 202002-1240-011
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/22/2020
	Date Received in OIRA: 10/20/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2022	01/31/2022	01/31/2022
Responses	3,900	0	3,900
Time Burden (Hours)	780	0	780
Cost Burden (Dollars)	3,721	0	3,721

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Abstract: Requesting address change for CM-908. Coal mine operators who pay monthly benefits must notify the Department's Division of Coal Mine Workers' Compensation (DCMWC) of any change in payments and the reason for that change. DCMWC uses this notification to monitor payments and ensure that beneficiaries receive the correct benefit rate.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 30783	06/29/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 46188	08/31/2018
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments	CM-908	Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments

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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	3,900	3,900	0	0	0	0
Annual Time Burden (Hours)	780	780	0	0	0	0
Annual Cost Burden (Dollars)	3,721	3,721	0	0	0	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:

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Annual Cost to Federal Government: $37,703

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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? No

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Common Form ICR:  No

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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: 10/20/2020

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