Application For Approval Of A Representative’s Fee In Black Lung Claims Proceedings Conducted By The U.s. Department Of Labor

NON- SUBSTANTIVE CHANGE REQUEST FOR THE APPLICATION FOR APPROVAL OF A REPRESENTATIVE’S FEE IN BLACK LUNG CLAIMS PROCEEDINGS CONDUCTED BY THE U.S. DEPARTMENT OF LABOR CM-972

OMB CONTROL NO. 1240-0011 (January 2024)

DCMWC is requesting a non-substantive change to the approved collection of information contained in the “Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor” to update the URL of the coal mine portal, add our toll-free telephone number, and change the suite number of DCMWC’s mailing address in the CM-972 Form.

DCMWC seeks to revise the approved CM-972 as follows:

• Two Filling Options:

1.To file electronically, submit completed form to the COAL Mine Portal: https://coalmine.dol.gov

2. To file by mail, submit completed form to:

OWCP/DCMWC/CMR Correspondence

PO Box 8307

London, KY 40742-8307

For Further information call TOLL FREE: 1-800-347-2502

• Under Public Burden Statement change address to 200 Constitution Avenue, N.W., Suite C3520-DCMWC, Washington, D.C. 20210

This change request does not affect the burden hours. The burden hours remain the same.

The revised form is attached to this change request.