Notice Of Issuance Of Insurance Policy

Justification CM-921.docx

Notice of Issuance of Insurance Policy

NOTICE OF ISSUANCE OF INSURANCE POLICY

OMB: 1240-0048

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NON- SUBSTANTIVE CHANGE REQUEST FOR THE NOTICE OF ISSUANCE OF INSURANCE POLICY CM-921

OMB CONTROL NO. 1240-0048 (January 2024)


DCMWC is requesting a non-substantive change to the recently approved collection of information contained in the “Notice of Issuance of Insurance Policy” to update the URL of the program’s forms and change of Suite number of DCMWC’s mailing address.



DCMWC seeks to revise the recently approved CM-921 as follows:


Instructions” change address to 200 Constitution Avenue, N.W., Suite C3520-DCMWC, Washington, D.C. 20210.


Report” Change URL address to: :https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black



Notice of Insurance Policy” change address to 200 Constitution Avenue, N.W., Suite C3520-DCMWC, Washington, D.C. 20210.


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


This change request does not affect the burden hours. The burden hours remain the same.


The revised form is attached to this change request.






File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleSUPPORTING STATEMENT FOR THE
AuthorOSHA_User
File Modified0000-00-00
File Created2024-07-20

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