Report of Changes That May Affect Your Black Lung Benefits

OMB: 1240-0028

IC ID: 13756

Documents and Forms

Document Name Document Type
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits Form
CM-929P Report of Changes That May Affect Your Black Lung Benefi cm-929P non-sub.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-929P Report of Changes That May Affect Your Black Lung Benefi cm-929P non-sub.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-929 Report of Changes That May Affect Your Black Lung Benefi cm-929 non-sub.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-929 Report of Changes That May Affect Your Black Lung Benefi cm-929 non-sub.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-929 Portal Report of changes Word version Portal request.docx eclaimant.dol.gov/portal/?program_name=BL Form
CM-929 Portal Report of changes Word version Portal request.docx eclaimant.dol.gov/portal/?program_name=BL Form
CM-929 Report of Changes That May Affect Your Black Lung Benefi 929 updated form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-929 Report of Changes That May Affect Your Black Lung Benefi 929 updated form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-929P Report of Changes That May Affect Your Black Lung Benefi 929P updated form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-929P Report of Changes That May Affect Your Black Lung Benefi 929P updated form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form

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 725.533(e) 20 CFR 725.513(a)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-929P	Report of Changes That May Affect Your Black Lung Benefits	cm-929P non-sub.docx	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-929	Report of Changes That May Affect Your Black Lung Benefits	cm-929 non-sub.docx	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-929	Portal Report of changes	Word version Portal request.docx	https://eclaimant.dol.gov/portal/?program_name=BL	Yes	Yes	Fillable Fileable
Form	CM-929	Report of Changes That May Affect Your Black Lung Benefits	929 updated form.docx	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-929P	Report of Changes That May Affect Your Black Lung Benefits	929P updated form.docx	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

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: 21,681	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	21,681	21,681
Annual IC Time Burden (Hours)	6,373	6,373
Annual IC Cost Burden (Dollars)	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.