Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments

ICR 202002-1240-011

OMB: 1240-0030

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Unchanged
Justification for No Material/Nonsubstantive Change
2020-02-20
Supplementary Document
2020-02-20
Supplementary Document
2018-07-31
Supporting Statement A
2018-08-30
Supplementary Document
2009-01-16
IC Document Collections
ICR Details
1240-0030 202002-1240-011
Historical Active 201807-1240-002
DOL/OWCP
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 02/27/2020
Retrieve Notice of Action (NOA) 02/21/2020
  Inventory as of this Action Requested Previously Approved
01/31/2022 01/31/2022 01/31/2022
3,900 0 3,900
780 0 780
3,721 0 3,721

Requesting address change for CM-908. Coal mine operators who pay monthly benefits must notify the Department's Division of Coal Mine Workers' Compensation (DCMWC) of any change in payments and the reason for that change. DCMWC uses this notification to monitor payments and ensure that beneficiaries receive the correct benefit rate.

US Code: 30 USC 901 Name of Law: Black Lung Benefits Act
  
None

Not associated with rulemaking

  83 FR 30783 06/29/2018
83 FR 46188 08/31/2018
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 3,900 3,900 0 0 0 0
Annual Time Burden (Hours) 780 780 0 0 0 0
Annual Cost Burden (Dollars) 3,721 3,721 0 0 0 0
No
No
Annual costs to respondents (Item 13) decreased due to fewer claims being paid by RO’s.

$37,703
No
    Yes
    Yes
No
No
No
Uncollected
Debbie Thurston 202 693-0913 Thurston.Debra@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.
02/21/2020


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