OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor

ICR 201003-1240-011 · OMB 1240-0011 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CM-972 Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor Form Unchanged Available
1215-0171 Justification for 83-C (CM-972) (2007 Clearance).pdf Justification for No Material/Nonsubstantive Change Uploaded 2009-06-18 Available
1215-0171 OMB-DOL QandA.doc Supplementary Document Uploaded 2007-12-17 Available
SS 1215-0171 05-2007 Final (Revised).doc Supporting Statement A Uploaded 2007-08-31 Repair queued
DOL-ESA-6.pdf Supplementary Document Uploaded 2007-05-31 Available
IC Document Collections
IC IDCollectionTypeStatusForm
13877 Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor Form Unchanged
ICR Details
1240-0011 201003-1240-011
Historical Active 200705-1215-005
DOL/OWCP
Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 03/12/2010
Retrieve Notice of Action (NOA) 03/12/2010
  Inventory as of this Action Requested Previously Approved
12/31/2010 12/31/2010
285 0 285
200 0 200
0 0 0
The purpose of the CM-972 is to collect pertinent data to determine if the representative's services and the amounts charged can be paid under the Black Lung Benefits Act.
US Code: 30 USC 901 Name of Law: Black Lung Benefits Act
  
None
Not associated with rulemaking
  72 FR 34049 06/20/2007
72 FR 52396 09/13/2007
No
  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 285 285 0 0 0 0
Annual Time Burden (Hours) 200 200 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There has been a slight increase in the number of attorney fee awards, the approximate number of CM-972's submitted by representatives may increase leading to an increase in the burden hours. There has been an adjustment of +30 in responses and an adjustment of +21 burden hours increase due to rounded from 199.50 to 200 by ROCIS.
$4,383
No
No
Uncollected
Uncollected
No
Uncollected
Michael McClaran 202-693-0978 [email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/18/2009