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Federal forms, ICRs, and supporting documents

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

IC 13877 under ICR 202401-1240-007 · OMB 1240-0011.

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Information Collection (IC) Details

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Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.366 20 CFR 725.365

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-972 APPLICATION FOR APPROVAL OF A REPRESENTATIVE’S FEE IN A BLACK LUNG CLAIM PROCEEDING CONDUCTED BY THE U.S. DEPARTMENT OF LABOR CM-972 Form.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable

Income Security Survivor Compensation

DOL/OWCP-2  81 FR 25858

590 276
   
Private Sector Businesses or other for-profits
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 590 0 0 0 0 590
Annual IC Time Burden (Hours) 413 0 0 0 0 413
Annual IC Cost Burden (Dollars) 204 0 0 0 0 204

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