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View ICR - OIRA Conclusion

OMB Control No: 1215-0052	ICR Reference No: 200203-1215-004
Status: Historical Inactive	Previous ICR Reference No: 199903-1215-004
Agency/Subagency: DOL/ESA	Agency Tracking No:
Title: 1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment history; 3) 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OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 05/30/2002
	Date Received in OIRA: 03/29/2002
Terms of Clearance: Withdrawn. DOL will submit an emergency extension request to determine when and where the information collected in #4 of form CM-911 should be elicited in the Black Lung benefits claims process.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2002	05/31/2005	08/31/2002
Responses	20,200	0	20,200
Time Burden (Hours)	9,116	0	0
Cost Burden (Dollars)	4,000	0	0

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