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

Forms and Documents

Document Name	Status
Form CM-908 Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form	Modified
Supporting Statement CM-908.docx Supporting Statement A	2021-12-14
1240-0030 Notice of Termination Suspension Reduction or Increase in Benefits (CM-908).pdf Supplementary Document	2020-08-27
Justification - Notification of Termination Suspension Reduction or Increase in Benefit Payments (CM-908).docx Justification for No Material/Nonsubstantive Change	2020-08-25
Justifiction - CM-908.docx Justification for No Material/Nonsubstantive Change	2020-02-20
CM-908 Notification of Termination, Suspension, Reduction, or Increase in Benefit Payments.pdf Supplementary Document	2020-02-20
System of Record Notice-DOL OWCP-2.pdf Supplementary Document	2018-07-31
20 CFR 725.621.pdf Supplementary Document	2009-01-16

IC Document Collections

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

ICR Details

OMB Control No: 1240-0030	ICR Reference No: 202110-1240-002
Status: Received in OIRA	Previous ICR Reference No: 202008-1240-043
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/23/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	01/31/2022
Responses	4,900	3,900
Time Burden (Hours)	980	780
Cost Burden (Dollars)	2,078	3,721

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Abstract: 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:
	86 FR 33377	06/24/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 72998	12/23/2021
Did the Agency receive public comments on this ICR? No

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

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

	Total Request	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	4,900	3,900	0	0	1,000	0
Annual Time Burden (Hours)	980	780	0	0	200	0
Annual Cost Burden (Dollars)	2,078	3,721	0	0	-1,643	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: Many RO’s have automated the information process and have preformatted this report for use in their insurers’ computer system so that a change in benefits automatically generates a CM-908 form. Annual number of respondents is higher due to an increase of claims paid by ROs. However, since we are receiving 20% (estimate) of the forms electronically the total respondent cost decrease. The estimated annual cost to the Federal Government increased because the number of responses increased, and the yearly wages also increase since the last update of the Supporting Statement issued in 2018. Specific Changes Made to CM-908: Page 1 – Updated Public Burden Statement Page 1 – Update Notice The burden hours increased by 200 hours (780 + 200 = 980). OWCP originally listed 4,900 as the number of respondents in the burden table. It has been corrected to 325. There is a decrease in capital costs by $1,643.00 ($3,721 – 2,077.60).

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Annual Cost to Federal Government: $16,905

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: 12/23/2021

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