Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim
ICR 201309-1240-004 · OMB 1240-0033 · Historical Active
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0033 can be found here:
Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim
Forms CM-2790 & CM-2970a are used for claims filed after January 19, 2001 and indicate that the coal mine operator will submit additional evidence or respond to the notice of claim.
US Code:
30 USC 901
Name of Law: Black Lung Benefits Act
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.
Form CM-2970 Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim
DOL Privacy Act Systems ESA-30.pdf
Supporting Statement for 1240-0033.doc
Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim