Miner's Claim for Benefits Under the Black Lung Benefits Act and Employment History
Revision of a currently approved collection
No
Regular
02/25/2022
Requested
Previously Approved
36 Months From Approved
03/31/2022
9,800
9,840
6,942
1,791
1,818
50,532
CM-911 is the standard application form filed by the miner for benefits under the Black Lung Benefits Act. The applicant lists the coal miner's work history on the CM-911a, and this form is completed by all applicants, both miners and survivors.
US Code:
30 USC 901
Name of Law: Black Lung Benefits Act
The annual number of responses decreased by 40 from 9,840 to 9,800. This decrease is a result of fewer claims filed. Also postage change rates from 52 cents to 53 cents and the pay rate for claims examiners also increased. The increase in hour burden is the result of a previous error in the calculation. The estimated cost for operations and maintenance has increased from $1,790.00 to $1,818.00 due to increased cost of postage. The decrease in $48,714 was to correct a previous calculation. The revisions to the form are discussed in Q15 of the Supporting Statement.
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-911a 1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment History
2022 Supporting Statement 1240-0038 FINAL.docx
System of Record Notice.pdf
1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment History