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: 199502-1215-002
Status: Historical Active	Previous ICR Reference No: 199202-1215-001
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: SURVIVOR'S CLAIM FOR BENEFITS UNDER THE BLACK LUNG BENEFITS ACT
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/20/1995
	Date Received in OIRA: 02/21/1995
Terms of Clearance: Approved as amended by DOL's memoranda to OMB of 4/13/95 and 4/18/95.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1996	03/31/1996	04/30/1995
Responses	1,200	0	0
Time Burden (Hours)	500	0	500
Cost Burden (Dollars)	0	0	0

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