Information Collection

Report of Changes That May Affect Your Black Lung Benefits

IC 13756 under ICR 202411-1240-002 · OMB 1240-0028.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits	Form
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits Report of Changes That May Affect Your Black Lung Benefits	Form
Form CM-929 Report of Changes That May Affect Your Black Lung Benefits Report of Changes That May Affect Your Black Lung Benefits	Form
Form CM-929 Portal Report of changes Report of Changes That May Affect Your Black Lung Benefits	Form
Form CM-929 Report of Changes That May Affect Your Black Lung Benefits Report of Changes That May Affect Your Black Lung Benefits	Form
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits Report of Changes That May Affect Your Black Lung Benefits	Form
Form CM-929 Report of Changes That May Affect Your Black Lung Benefits Report of Changes That May Affect Your Black Lung Benefits	Form
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits 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
CM-929 Report of Changes That May Affect Your Black Lung Benefi CM-929 - Report of Changes That May Affect Your Black Lung Benefits-Spanish Version.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 - Report of Changes That May Affect Your Black Lung Benefits-Spanish Version.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 - Report of Changes Than May Effect Your BL Benefits- Spanish Version.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 - Report of Changes Than May Effect Your BL Benefits- Spanish Version.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:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-929P	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-929	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-929	https://eclaimant.dol.gov/portal/?program_name=BL	Yes	Yes	Fillable Fileable
Form	CM-929	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-929P	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-929	https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black	Yes	Yes	Fillable Printable
Form	CM-929P	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 %

table that charts list of burden
	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

table that charts IC Documents
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.

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