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: 200407-1215-004
Status: Historical Active	Previous ICR Reference No: 200206-1215-005
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: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/10/2004
	Date Received in OIRA: 07/10/2004
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2005	09/30/2005	08/31/2005
Responses	10,700	0	20,200
Time Burden (Hours)	7,533	0	9,116
Cost Burden (Dollars)	1,000	0	4,000

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	10,700	20,200	-9,500
Annual Time Burden (Hours)	7,533	9,116	-1,583
Annual Cost Burden (Dollars)	1,000	4,000	-3,000

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: Yes

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.