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OMB Control No: 1240-0011	ICR Reference No: 202603-1240-003
Status: Received in OIRA	Previous ICR Reference No: 202401-1240-007
Agency/Subagency: DOL/OWCP	Agency Tracking No:
Title: Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/29/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2026
Responses	820	590
Time Burden (Hours)	574	413
Cost Burden (Dollars)	340	204

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Adjustment in Estimate
Annual Number of Responses	820	590	230
Annual Time Burden (Hours)	574	413	161
Annual Cost Burden (Dollars)	340	204	136

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: EXPLANATION OF CHANGE TOTALS Respondents: The number of respondents increased from 590 to 820. The number of respondents increased due to an increased number of attorney fee awards issued. The following also increased due to an increase in number of forms received/responses and increase in postage rates. Responses: Responses have increased from 590 to 820. Burden Hours: Burden hours have increased from 413 to 574. Costs: Annual burden costs have increased from $204.00 to $340.00.

Annual Cost to Federal Government: $19,992

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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