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: 1215-0052	ICR Reference No: 199112-1215-003
Status: Historical Active	Previous ICR Reference No: 198904-1215-001
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: MINER'S CLAIM FOR BENEFITS UNDER THE BLACK LUNG ACT, EMPLOYMENT HISTORY, AND MINER MEDICAL REIMBURSEMENT FORM
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/30/1992
	Date Received in OIRA: 12/31/1991
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/1995	04/30/1995	06/30/1992
Responses	52,700	0	54,500
Time Burden (Hours)	14,533	0	17,166
Cost Burden (Dollars)	0	0	0

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.