Claim Adjudication Process For The Alleged Presence Of Pneumoconiosis

NON- SUBSTANTIVE CHANGE REQUEST FOR THE CLAIM ADJUDICATION PROCESS FOR THE ALLEGED PRESENCE OF PNEUMOCONIOSIS” FORMS CM-933, CM-933b, CM-2907, CM-1159 & CM-988

OMB CONTROL NO. 1240-0023 (January 2024)

DCMWC is requesting a non-substantive change to the recently approved collection of information contained in the “Claim Adjudication Process for the Alleged Presence of Pneumoconiosis” to update the URL of the coal mine portal, add our toll-free telephone number and change the suite number of DCMWC’s mailing address.

DCMWC seeks to revise the recently approved CM-933, CM-933b, CM-2907, CM-1159 & CM-988 as follows:

• TWO FILING OPTIONS:

1. To file electronically, submit completed form to the COAL Mine Portal:

https://coalmine.dol.gov

2. To file by mail, send completed form to:

US Department of Labor

OWCP/DCMWC

PO Box 8307

London, KY 40742-8307

For Further Information call TOLL FREE: 1-800-347-2502

• Under Public Burden Statement change address to 200 Constitution Avenue, N.W., Suite C3520-DCMWC, Washington, D.C. 20210.

These changes request do not affect the burden hours. The burden hours remain the same.

The revised forms are attached to this change request.