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View ICR - OIRA Conclusion

OMB Control No: 1240-0057	ICR Reference No: 202404-1240-003
Status: Active	Previous ICR Reference No: 202401-1240-005
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Application for Self-Insurance Under the Black Lung Benefits Act
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: 02/25/2025
	Date Received in OIRA: 01/15/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2028	36 Months From Approved	11/30/2025
Responses	142	0	294
Time Burden (Hours)	246	0	261
Cost Burden (Dollars)	34,000	0	34,080

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	142	294	-176	24
Annual Time Burden (Hours)	246	261	-63	48
Annual Cost Burden (Dollars)	34,000	34,080	-80	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: Yes

Burden Reduction Due to: Changing Regulations

Short Statement: The final rule contains information collections within the meaning of the PRA, but these collections are not new. Aside from the removal of the collection associated with submitting form CM-2017a to OWCP, the requirements for completion of the forms and the information collected on the forms will not change if this proposed rule is adopted. Respondents: The estimated number of self-insured operators has increased from 49 to 61. The number of respondents increased due to increased number of estimated applications for self-insurance. Both the below estimated annualized responses and burden hours have decreased due to the removal of the CM-2017a form despite the increase in respondents. Responses: Responses have decreased from 294 to 122. Burden Hours: Burden hours have decreased from 261 to 244. Costs: Annual burden costs have decreased from $34,080 to $34,000 due to the removal of the associated mailing costs.

Annual Cost to Federal Government: $15,695

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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