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: 1240-0038	ICR Reference No: 201602-1240-004
Status: Historical Active	Previous ICR Reference No: 201405-1240-005
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Miner's Claim for Benefits Under the Black Lung Benefits Act and Employment History
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: 04/04/2016
	Date Received in OIRA: 03/02/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2018	01/31/2018	01/31/2018
Responses	11,000	0	11,000
Time Burden (Hours)	7,750	0	7,750
Cost Burden (Dollars)	2,058	0	2,058

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