Report of Changes That May Affect Your Black Lung Benefits

ICR 201003-1240-028

OMB: 1240-0028

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2008-06-11
Supporting Statement A
2008-04-10
Supplementary Document
2008-04-09
Supplementary Document
2008-04-09
Supplementary Document
2008-04-02
Supplementary Document
2008-03-12
Supplementary Document
2008-03-12
IC Document Collections
ICR Details
1240-0028 201003-1240-028
Historical Active 200504-1215-002
DOL/OWCP
Report of Changes That May Affect Your Black Lung Benefits
Revision of a currently approved collection   No
Regular
Approved without change 03/12/2010
Retrieve Notice of Action (NOA) 03/12/2010
  Inventory as of this Action Requested Previously Approved
06/30/2011 36 Months From Approved
70,000 0 51,000
15,269 0 4,505
0 0 0

To help determine continuing eligibility of primary beneficiaries receiving black lung benefits from the Disability Trust Fund. To verify and update on a regular basis factors that affect a beneficiary's entitlement to benefits, including income, marital status, receipt of State Worker's Compensation, and dependent status.

US Code: 30 USC 936 Name of Law: Federal Mine Safety and Health Act
  
None

Not associated with rulemaking

  72 FR 70616 12/12/2007
73 FR 22432 04/25/2008
No

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 70,000 51,000 0 19,000 0 0
Annual Time Burden (Hours) 15,269 4,505 0 10,764 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The total burden hours have increased by 10,764 hours, from 4,505 to 15,269. The burden hours have increased because of a program change in requiring reporting of benefits received annually instead of biennially in order to ensure more accurate payment of benefits.

$502,106
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Michael McClaran 202-693-0978 mcclaran.michael@dol.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
04/25/2008


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