View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 1215-0069	ICR Reference No: 197812-1215-008
Status: Historical Active	Previous ICR Reference No: 197808-1215-010
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: CLAIM FOR BENEFITS UNDER THE BLACK LUNG BENEIFTS ACT (WIDOW OR SURVIVING DIVORCED WIFE)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 12/31/1978
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/31/1978
	Date Received in OIRA: 12/31/1978
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/1983	07/31/1983	07/31/1983
Responses	8,000	0	2,000
Time Burden (Hours)	2,666	0	666
Cost Burden (Dollars)	0	0	0

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