Information Collection

DOL OWCP Black Lung - Claimants with Pending Claim

IC 259961 under ICR 202503-1225-001 · OMB 1225-0093.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1225-0093 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DOL OWCP Black Lung - Claimants with Pending Claim	Form
OWCP Black Lung CX Survey - Claimants with a Pending Claim DOL OWCP Black Lung - Claimants with Pending Claim	Form
Black Lung Survey- Pending Claim - Instructions Updated 5-1-2023 (002).docx	Instruction
Black Lung Survey- Pending Claim - Instructions Updated 5-1-2023 (002).docx	Instruction
OWCP Black Lung CX Survey - Claimants with a Pending Cla CX Survey-Claimants with a Pending Claim 5-1-2023.docx	Form
OWCP Black Lung CX Survey - Claimants with a Pending Cla CX Survey-Claimants with a Pending Claim 5-1-2023.docx	Form
1225-0093 - A11 Section 280 Clearance - Black Lung-Pending Claims 5.1.docx 1225-0093 - OWCP Black Lung - Pending Claims	IC Document
1225-0093 - A11 Section 280 Clearance - Black Lung-Pending Claims 5.1.docx 1225-0093 - OWCP Black Lung - Pending Claims	IC Document

IC Title:

DOL OWCP Black Lung - Claimants with Pending Claim

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA				No		Paper Only
Instruction					No		Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1225-0093 - OWCP Black Lung - Pending Claims		05/01/2023

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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