OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Application for Self-Insurance Under the Black Lung Benefits Act

ICR 202404-1240-003 · OMB 1240-0057 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form CM-2017 Application for Self-Insurance Under the black Lung Benefits Act Form Modified Repair queued
8.19.24 Supporting Statement 1240-0057 - Final.docx Supporting Statement A Uploaded 2024-08-19 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
234819 Application for Self-Insurance Under the black Lung Benefits Act Form Modified
ICR Details
1240-0057 202404-1240-003
Received in OIRA 202401-1240-005
DOL/OWCP
Application for Self-Insurance Under the Black Lung Benefits Act
Revision of a currently approved collection   No
Regular 01/15/2025
  Requested Previously Approved
36 Months From Approved 11/30/2025
142 294
246 261
34,000 34,080
This information collection is essential to the mission of OWCP’s Division of Coal Mine Workers’ Compensation, which administers the Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et seq. The statute grants the Department authority to authorize and regulate coal mine operators who wish to self-insure their BLBA liabilities. 30 U.S.C. 933. This information collection would provide OWCP with sufficient information to determine whether a coal mine operator should be (or continue to be) authorized to self-insure. The information would also allow OWCP to determine the security amount a coal mine operator must deposit to guarantee that it will be able to meet its BLBA liabilities.
US Code: 30 USC 933 Name of Law: Black Lung Benefits Act (BLBA)
  
None
1240-AA16 Final or interim final rulemaking 89 FR 100304 12/12/2024
Yes
  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 142 294 0 -176 24 0
Annual Time Burden (Hours) 246 261 0 -63 48 0
Annual Cost Burden (Dollars) 34,000 34,080 0 -80 0 0
No
Yes
Changing Regulations
The final rule contains information collections within the meaning of the PRA, but these collections are not new. Aside from the removal of the collection associated with submitting form CM-2017a to OWCP, the requirements for completion of the forms and the information collected on the forms will not change if this proposed rule is adopted. Respondents: The estimated number of self-insured operators has increased from 49 to 61. The number of respondents increased due to increased number of estimated applications for self-insurance. Both the below estimated annualized responses and burden hours have decreased due to the removal of the CM-2017a form despite the increase in respondents. Responses: Responses have decreased from 294 to 122. Burden Hours: Burden hours have decreased from 261 to 244. Costs: Annual burden costs have decreased from $34,080 to $34,000 due to the removal of the associated mailing costs.
$15,695
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.
01/15/2025