OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Report of Changes That May Affect Your Black Lung Benefits

IC 13756 under ICR 202411-1240-002 · OMB 1240-0028.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Report of Changes That May Affect Your Black Lung Benefits
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 725.533(e) 20 CFR 725.513(a)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits cm-929P non-sub.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-929 Report of Changes That May Affect Your Black Lung Benefits cm-929 non-sub.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-929 Portal Report of changes Word version Portal request.docx https://eclaimant.dol.gov/portal/?program_name=BL Yes Yes Fillable Fileable
Form CM-929 Report of Changes That May Affect Your Black Lung Benefits 929 updated form.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits 929P updated form.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-929 Report of Changes That May Affect Your Black Lung Benefits CM-929 - Report of Changes That May Affect Your Black Lung Benefits-Spanish Version.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable
Form CM-929P Report of Changes That May Affect Your Black Lung Benefits CM-929P - Report of Changes Than May Effect Your BL Benefits- Spanish Version.docx https://www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Yes Yes Fillable Printable

Income Security General Retirement and Disability

DOL/OWCP-2 and DOL/OWCP-9   81 FR 25765

21,681 0
   
Individuals or Households
 
   0 %

  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 21,681 0 0 0 0 21,681
Annual IC Time Burden (Hours) 6,373 0 0 0 0 6,373
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.