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Federal forms, ICRs, and supporting documents

Information Collection Request

Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments

ICR 202110-1240-002 · OMB 1240-0030 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form CM-908 Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form Modified Repair queued
Supporting Statement CM-908.docx Supporting Statement A Uploaded 2021-12-14 Repair queued
1240-0030 Notice of Termination Suspension Reduction or Increase in Benefits (CM-908).pdf Supplementary Document Uploaded 2020-08-27 Repair queued
Justification - Notification of Termination Suspension Reduction or Increase in Benefit Payments (CM-908).docx Justification for No Material/Nonsubstantive Change Uploaded 2020-08-25 Repair queued
Justifiction - CM-908.docx Justification for No Material/Nonsubstantive Change Uploaded 2020-02-20 Missing upstream
CM-908 Notification of Termination, Suspension, Reduction, or Increase in Benefit Payments.pdf Supplementary Document Uploaded 2020-02-20 Repair queued
System of Record Notice-DOL OWCP-2.pdf Supplementary Document Uploaded 2018-07-31 Repair queued
20 CFR 725.621.pdf Supplementary Document Uploaded 2009-01-16 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
43806 Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form Modified
ICR Details
1240-0030 202110-1240-002
Received in OIRA 202008-1240-043
DOL/OWCP
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments
Revision of a currently approved collection   No
Regular 12/23/2021
  Requested Previously Approved
36 Months From Approved 01/31/2022
4,900 3,900
980 780
2,078 3,721
Coal mine operators who pay monthly benefits must notify the Department's Division of Coal Mine Workers' Compensation (DCMWC) of any change in payments and the reason for that change. DCMWC uses this notification to monitor payments and ensure that beneficiaries receive the correct benefit rate.
US Code: 30 USC 901 Name of Law: Black Lung Benefits Act
  
None
Not associated with rulemaking
  86 FR 33377 06/24/2021
86 FR 72998 12/23/2021
No
  Total Request 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 4,900 3,900 0 0 1,000 0
Annual Time Burden (Hours) 980 780 0 0 200 0
Annual Cost Burden (Dollars) 2,078 3,721 0 0 -1,643 0
No
No
Many RO’s have automated the information process and have preformatted this report for use in their insurers’ computer system so that a change in benefits automatically generates a CM-908 form. Annual number of respondents is higher due to an increase of claims paid by ROs. However, since we are receiving 20% (estimate) of the forms electronically the total respondent cost decrease. The estimated annual cost to the Federal Government increased because the number of responses increased, and the yearly wages also increase since the last update of the Supporting Statement issued in 2018. Specific Changes Made to CM-908: Page 1 – Updated Public Burden Statement Page 1 – Update Notice The burden hours increased by 200 hours (780 + 200 = 980). OWCP originally listed 4,900 as the number of respondents in the burden table. It has been corrected to 325. There is a decrease in capital costs by $1,643.00 ($3,721 – 2,077.60).
$16,905
No
    Yes
    Yes
No
No
No
No
Marcela Meneses 304 420-1232 [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.
12/23/2021