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View ICR - OIRA Conclusion

OMB Control No: 1240-0027	ICR Reference No: 201607-1240-001
Status: Historical Active	Previous ICR Reference No: 201510-1240-003
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Survivor's Form 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: 03/02/2017
	Date Received in OIRA: 12/28/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved	03/31/2017
Responses	1,100	0	1,100
Time Burden (Hours)	147	0	147
Cost Burden (Dollars)	450	0	441

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