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View ICR - OIRA Conclusion

OMB Control No: 1240-0038	ICR Reference No: 202305-1240-002
Status: Historical Active	Previous ICR Reference No: 202109-1240-003
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Miner's Claim for Benefits Under the Black Lung Benefits Act CM-911 and Employment History CM-911a
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: 10/24/2023
	Date Received in OIRA: 09/20/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2026	36 Months From Approved	04/30/2025
Responses	10,020	0	9,800
Time Burden (Hours)	8,768	0	6,942
Cost Burden (Dollars)	2,420	0	1,818

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	10,020	9,800	220
Annual Time Burden (Hours)	8,768	6,942	1,826
Annual Cost Burden (Dollars)	2,420	1,818	602

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: EXPLANATION OF CHANGE TOTALS Respondents: The number of respondents increased from 9,800 to 10,020. The number of respondents increased due to an increased of claims field. Responses: Responses have increased from 9,800 to 10,020 due to an increased in number of forms received/responses. Burden Hours: Burden hours have increased from 6,942 to 8,768 due to an increase of the time burden for the CM-911a. The proposed CM-911a is a combination of the current CM-911a and the current CM-913. The CM-913 is a separate ICR and once the proposed CM911a is approved, our program plans to discontinue the current CM-913. This change will eliminate the burden on the respondents from having to complete two separate employment forms to completing one. Costs: Annual burden costs have increased from $1,818 to $2,315 due to an increase of postage.

Annual Cost to Federal Government: $227,003

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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