Description of Coal Mine Work and Other Employment

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0035 can be found here:

Documents and Forms

Document Name Document Type
Form CM-913 Description of Coal Mine Work and Other Employment Form
CM-913 Comparability of Current Work to Coal Mine Employment cm-913.pdf www.dol.gov/regs/compliance/owcp/cm-913.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Description of Coal Mine Work and Other Employment	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 718.204

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CM-913	Comparability of Current Work to Coal Mine Employment	cm-913.pdf	http://www.dol.gov/regs/compliance/owcp/cm-913.pdf	Yes	Yes	Fillable Printable

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records
Title: DOL/ESA-6	FR Citation: 67 FR 16869

Number of Respondents: 1,650	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,650	0	1,650
Annual IC Time Burden (Hours)	1,100	275	825
Annual IC Cost Burden (Dollars)	858	0	858

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.