View Information Collection Request (ICR) Package
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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:
1240-0030
ICR Reference No:
202110-1240-002
Status:
Historical Active
Previous ICR Reference No:
202008-1240-043
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments
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:
02/17/2022
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/23/2021
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2025
36 Months From Approved
02/28/2022
Responses
4,900
0
3,900
Time Burden (Hours)
980
0
780
Cost Burden (Dollars)
2,078
0
3,721
Abstract:
Coal mine operators who pay monthly benefits must notify the Department's Division of Coal Mine Workers' Compensation (DCMWC) of any change in payments and the reason for that change. DCMWC uses this notification to monitor payments and ensure that beneficiaries receive the correct benefit rate.
Authorizing Statute(s):
US Code:
30 USC 901
Name of Law: Black Lung Benefits Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
86 FR 33377
06/24/2021
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 72998
12/23/2021
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments
CM-908
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
4,900
3,900
0
0
1,000
0
Annual Time Burden (Hours)
980
780
0
0
200
0
Annual Cost Burden (Dollars)
2,078
3,721
0
0
-1,643
0
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:
Many RO’s have automated the information process and have preformatted this report for use in their insurers’ computer system so that a change in benefits automatically generates a CM-908 form. Annual number of respondents is higher due to an increase of claims paid by ROs. However, since we are receiving 20% (estimate) of the forms electronically the total respondent cost decrease. The estimated annual cost to the Federal Government increased because the number of responses increased, and the yearly wages also increase since the last update of the Supporting Statement issued in 2018. Specific Changes Made to CM-908: Page 1 – Updated Public Burden Statement Page 1 – Update Notice The burden hours increased by 200 hours (780 + 200 = 980). OWCP originally listed 4,900 as the number of respondents in the burden table. It has been corrected to 325. There is a decrease in capital costs by $1,643.00 ($3,721 – 2,077.60).
Annual Cost to Federal Government:
$16,905
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
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
12/23/2021
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