View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 1240-0038	ICR Reference No: 202109-1240-003
Status: Historical Active	Previous ICR Reference No: 201712-1240-003
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: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/01/2022
	Date Received in OIRA: 02/25/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2025	36 Months From Approved	03/31/2022
Responses	9,800	0	9,840
Time Burden (Hours)	6,942	0	1,791
Cost Burden (Dollars)	1,818	0	50,532

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	9,800	9,840	-40
Annual Time Burden (Hours)	6,942	1,791	5,151
Annual Cost Burden (Dollars)	1,818	50,532	-48,714

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: The annual number of responses decreased by 40 from 9,840 to 9,800. This decrease is a result of fewer claims filed. Also postage change rates from 52 cents to 53 cents and the pay rate for claims examiners also increased. The increase in hour burden is the result of a previous error in the calculation. The estimated cost for operations and maintenance has increased from $1,790.00 to $1,818.00 due to increased cost of postage. The decrease in $48,714 was to correct a previous calculation. The revisions to the form are discussed in Q15 of the Supporting Statement.

Annual Cost to Federal Government: $207,491

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Marcela Meneses 304 420-1232 meneses.marcela@dol.gov

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