OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Coal Mine Operator Response to Schedule for Submission of Additional Evidence and Operator Response to Notice of Claim

ICR 201611-1240-002 · OMB 1240-0033 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form CM-2970 Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim Form Modified Repair queued
FRN Notice for SORN.pdf Supplementary Document Uploaded 2017-03-13 Available
2017 Supporting Statement 1240-0033 CM-2970 and CM-2970a.doc Supporting Statement A Uploaded 2017-03-21 Repair queued
20CFR725.407-408.pdf Supplementary Document Uploaded 2007-08-08 Available
20CFR725.412.pdf Supplementary Document Uploaded 2007-08-08 Available
IC Document Collections
IC IDCollectionTypeStatusForm
13697 Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim Form Modified
ICR Details
1240-0033 201611-1240-002
Historical Active 201309-1240-004
DOL/OWCP
Coal Mine Operator Response to Schedule for Submission of Additional Evidence and Operator Response to Notice of Claim
Extension without change of a currently approved collection   No
Regular
Approved without change 06/16/2017
Retrieve Notice of Action (NOA) 03/22/2017
  Inventory as of this Action Requested Previously Approved
06/30/2020 36 Months From Approved 06/30/2017
9,600 0 9,600
2,000 0 2,000
4,800 0 4,704
The OWCP, Division of Coal Mine Workers' Compensation (DCMWC) administers the Black Lung Benefits Act (30 U.S.C. 901 et seq.), which provides benefits to coal miners totally disabled due to pneumoconiosis and their surviving dependents. When the DCMWC makes a preliminary analysis of a claimant's eligibility for benefits, and if a coal mine operator has been identified as potentially liable for payment of those benefits, the responsible operator is notified of the preliminary analysis. Regulations codified at 20 CFR part 725 require that a coal mine operator be identified and notified of potential liability as early in the adjudication process as possible. Coal Mine Operator Response to Schedule for Submission of Additional Evidence (Form CM-2970) and Operator Response to Notice of Claim (Form 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
  
None
Not associated with rulemaking
  81 FR 78863 11/09/2016
82 FR 14751 03/22/2017
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 9,600 9,600 0 0 0 0
Annual Time Burden (Hours) 2,000 2,000 0 0 0 0
Annual Cost Burden (Dollars) 4,800 4,704 0 0 96 0
No
No
$34,744
No
No
No
No
No
Uncollected
Debbie Thurston 202 693-0913 [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.
03/22/2017