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Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim
Coal Mine Operator Response to Schedule for Submission of Additional Evidence and Operator Response to Notice of Claim
OMB: 1240-0033
IC ID: 13697
OMB.report
DOL/OWCP
OMB 1240-0033
ICR 202401-1240-003
IC 13697
( )
Documents and Forms
Document Name
Document Type
Form CM-2970
Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim
Form
Form CM-2970
Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim
Form
CM-2970 OPERATOR RESPONSE TO SCHEDULE FOR SUBMISSION OF ADDITION
CM-2970 Form.docx
www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black
Form
CM-2970 OPERATOR RESPONSE TO SCHEDULE FOR SUBMISSION OF ADDITION
CM-2970 Form.docx
www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black
Form
CM-2970a OPERATOR RESPONSE TO NOTICE OF CLAIM
CM-2970a Form.docx
www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black
Form
CM-2970a OPERATOR RESPONSE TO NOTICE OF CLAIM
CM-2970a Form.docx
www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
20 CFR 725.412a
20 CFR 725.408(a)(2)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
CM-2970
OPERATOR RESPONSE TO SCHEDULE FOR SUBMISSION OF ADDITIONAL EVIDENCE
CM-2970 Form.docx
https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black
Yes
Yes
Fillable Printable
Form
CM-2970a
OPERATOR RESPONSE TO NOTICE OF CLAIM
CM-2970a Form.docx
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 25858
Number of Respondents:
5,294
Number of Respondents for Small Entity:
4,900
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits
Percentage of Respondents Reporting Electronically:
70 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
5,294
0
0
0
0
5,294
Annual IC Time Burden (Hours)
1,173
0
0
0
0
1,173
Annual IC Cost Burden (Dollars)
1,096
0
0
0
0
1,096
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.