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:
1240-0054
ICR Reference No:
202502-1240-006
Status:
Active
Previous ICR Reference No:
202201-1240-002
Agency/Subagency:
DOL/OWCP
Agency Tracking No:
Title:
Disclosure of Medical Evidence
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:
07/11/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/04/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2028
36 Months From Approved
08/31/2025
Responses
6,797
0
6,105
Time Burden (Hours)
1,135
0
1,018
Cost Burden (Dollars)
16,041
0
10,745
Abstract:
The Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et seq., may require parties to exchange all medical information about the miner they develop in connection with a claim for benefits, including information parties do not intent to submit as evidence in the claim. BLBA regulations help protect a miner's health, assist unrepresented parties, and promote accurate benefit determinations. The potential parties to a BLBA claim include the benefits claimant, the responsible coal mine operator and its insurance carrier, and the Director of OWCP. Under BLBA, a party of a party's agent who receives medical information about the miner must send a copy to all other parties within 30 days after receipt or, if a hearing before an administrative law judge has already been scheduled, at least 20 days before the hearing. The exchanged information is entered into the record of the claim only if a party submits it into evidence.
Authorizing Statute(s):
US Code:
30 USC 901
Name of Law: Black Lung Benefits Act
US Code:
30 USC 936
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:
90 FR 11191
03/04/2025
30-day Notice:
Federal Register Citation:
Citation Date:
90 FR 23714
06/04/2025
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
Disclosure of Medical Evidence
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
6,797
6,105
0
692
0
0
Annual Time Burden (Hours)
1,135
1,018
0
117
0
0
Annual Cost Burden (Dollars)
16,041
10,745
0
5,296
0
0
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:
Respondents: The number of respondents increased from 6,105 to 6,797. The number of respondents increased due to an increase of the number of black lung cases adjudicated by OWCP and the Office of Administrative Law Judges. The following also increased due to an increased in number of respondents. Responses: Responses have increased from 6,105 to 6,797. Burden Hours: Burden hours have increased from 1,018 to 1,135. Costs: Annual burden costs have increased from $10,745 to $16,041 due to the increase in postage and increased number of responses. Also, the average number of pages submitted for disclosure purposes only increased from 3 pages to 4 pages.
Annual Cost to Federal Government:
$16,041
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:
06/04/2025
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