Report of Changes That May Affect Your Black Lung Benefits

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0028 can be found here:

Documents and Forms

Document Name Document Type
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits Form and Instruction
CM-929 Report of Changes That May Affect Your Black Lung Benefi CM-929.pdf www.dol.gov/owcp/regs/compliance/cm-929.pdf Form and Instruction
CM-929 Report of Changes That May Affect Your Black Lung Benefi CM-929.pdf www.dol.gov/owcp/regs/compliance/cm-929.pdf Form and Instruction
CM-929P Report of Changes That May Affect Your Black Lung Benefi CM-929P.pdf www.dol.gov/owcp/regs/compliance/cm-929P.pdf Form and Instruction
CM-929P Report of Changes That May Affect Your Black Lung Benefi CM-929P.pdf www.dol.gov/owcp/regs/compliance/cm-929P.pdf Form and Instruction
CM-929 Report of Changes That May Affect Your Black Lung Benefi 20210106 Form CM-929 Final.docx www.dol.gov/owcp/regs/compliance/cm-929P.pdf Form and Instruction
CM-929 Report of Changes That May Affect Your Black Lung Benefi 20210106 Form CM-929 Final.docx www.dol.gov/owcp/regs/compliance/cm-929P.pdf Form and Instruction
CM-929P Report of Changes That May Accect Your Black Lung Benefi 20210106 Form CM-929p Final.docx www.dol.gov/owcp/regs/compliance/cm-929P.pdf Form and Instruction
CM-929P Report of Changes That May Accect Your Black Lung Benefi 20210106 Form CM-929p Final.docx www.dol.gov/owcp/regs/compliance/cm-929P.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Report of Changes That May Affect Your Black Lung Benefits	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 725.513(a) 20 CFR 725.533(e)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	CM-929	Report of Changes That May Affect Your Black Lung Benefits	CM-929.pdf	http://www.dol.gov/owcp/regs/compliance/cm-929.pdf	Yes	No	Printable Only
Form and Instruction	CM-929P	Report of Changes That May Affect Your Black Lung Benefits	CM-929P.pdf	http://www.dol.gov/owcp/regs/compliance/cm-929P.pdf	Yes	No	Printable Only
Form and Instruction	CM-929	Report of Changes That May Affect Your Black Lung Benefits	20210106 Form CM-929 Final.docx	http://www.dol.gov/owcp/regs/compliance/cm-929P.pdf	Yes	Yes	Fillable Printable
Form and Instruction	CM-929P	Report of Changes That May Accect Your Black Lung Benefits	20210106 Form CM-929p Final.docx	http://www.dol.gov/owcp/regs/compliance/cm-929P.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: 12,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,000	-14,000	26,000
Annual IC Time Burden (Hours)	2,810	-3,279	6,089
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.