Information Collection Request
Claim Adjudication Process for the Alleged Presence of Pneumoconiosis
ICR 202401-1240-006 · OMB 1240-0023 · Active
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form CM-933 Radiologic Interpretation (CM-933), Radiologic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of.... |
Form | Modified | Available |
| Form CM-933 Radiologic Interpretation (CM-933), Radiologic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of.... |
Form | Modified | Repair queued |
 SS 1240-0023 2023_MN-MM.docx |
Supporting Statement A | Uploaded 2024-01-30 | Available |
| SS 1240-0023 2023_MN-MM.docx |
Supporting Statement A | Uploaded 2024-01-30 | Repair queued |
| Justification 1240-0023.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-01-30 | Available |
| Justification 1240-0023.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-01-30 | Repair queued |
 725.406.pdf |
Supplementary Document | Uploaded 2020-05-04 | Available |
| 725.406.pdf |
Supplementary Document | Uploaded 2020-05-04 | Missing upstream |
| 718.204.pdf |
Supplementary Document | Uploaded 2020-05-04 | Available |
| 718.204.pdf |
Supplementary Document | Uploaded 2020-05-04 | Repair queued |
| 718.202.pdf |
Supplementary Document | Uploaded 2020-05-04 | Available |
| 718.202.pdf |
Supplementary Document | Uploaded 2020-05-04 | Repair queued |
| DOL-OWCP-9.pdf |
Supplementary Document | Uploaded 2020-05-04 | Available |
| DOL-OWCP-9.pdf |
Supplementary Document | Uploaded 2020-05-04 | Repair queued |
| CM-988 Medical History and Examination for Coal Mine Workers' Pneumoconiosis.pdf |
Supplementary Document | Uploaded 2020-02-19 | Available |
| CM-988 Medical History and Examination for Coal Mine Workers' Pneumoconiosis.pdf |
Supplementary Document | Uploaded 2020-02-19 | Missing upstream |
| DOL-OWCP-2.pdf |
Supplementary Document | Uploaded 2020-05-04 | Available |
| DOL-OWCP-2.pdf |
Supplementary Document | Uploaded 2020-05-04 | Repair queued |
| 1240-0023 20CFR718.101 - 105.pdf |
Supplementary Document | Uploaded 2011-05-27 | Available |
| 1240-0023 20CFR718.101 - 105.pdf |
Supplementary Document | Uploaded 2011-05-27 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 13765 |  Radiologic Interpretation (CM-933), Radiologic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of.... |
Form | Modified | |
| 13765 | Radiologic Interpretation (CM-933), Radiologic Quality Rereading (CM-933b), Medical History and Examination for Coal Mine Workers' Pneumoconiosis (CM-988), Report of.... |
Form | Modified |
ICR Details
| Status | Active |
|---|---|
| Agency/Subagency | DOL/OWCP |
| OMB Control No | 1240-0023 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202306-1240-001 |
| Date Submitted to OIRA | 2024-01-31 |
| Requested Expiration Date | 1969-12-31 |