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: 199602-1215-003
Status: Historical Active	Previous ICR Reference No: 199502-1215-001
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: Miner's Claim for Benefits under the Black Lung Benefits Act, Employment History, Miner Reimbursement Form
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: 04/29/1996
	Date Received in OIRA: 02/29/1996
Terms of Clearance: Approved as amended by DOL memorandum of 4/23/96, 4/24/96 and 4/25/96. It is noted however that ESA shall recognize in future PRA submissions that there is a burden cost placed on the beneficiaries when filling out these forms despite the respondents current employment status.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/1999	05/31/1999	04/30/1996
Responses	20,200	0	52,700
Time Burden (Hours)	9,116	0	14,533
Cost Burden (Dollars)	3,000	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	20,200	52,700	0	-32,500
Annual Time Burden (Hours)	9,116	14,533	0	-5,417
Annual Cost Burden (Dollars)	3,000	0	3,000	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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