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Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202505-1240-003 · OMB 1240-0030 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form CM-908 Notice of Termination, Suspension, or Increase in Benefit Payment Form Modified Repair queued
Form CM-908 Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form Modified Repair queued
Supporting Statement 1240-0030 CM-908 2025 -OCIO1.docx Supporting Statement A Uploaded 2025-09-09 Repair queued
Supporting Statement 1240-0030 CM-908 2025 -OCIO1.docx Supporting Statement A Uploaded 2025-09-09 Missing upstream
Justification 908.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-30 Repair queued
Justification 908.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-30 Repair queued
System of Record Notice-DOL OWCP-2.pdf Supplementary Document Uploaded 2018-07-31 Available
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 Available
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 ModifiedNotice of Termination, Suspension, or Increase in Benefit Payment
43806 Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form Modified
ICR Details
1240-0030 202505-1240-003
Active 202401-1240-002
DOL/OWCP
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments
Extension without change of a currently approved collection   No
Regular
Approved without change 11/17/2025
Retrieve Notice of Action (NOA) 09/12/2025
  Inventory as of this Action Requested Previously Approved
11/30/2028 36 Months From Approved 11/30/2025
6,607 0 6,081
1,321 0 1,216
3,607 0 2,578
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
  90 FR 23961 06/05/2025
90 FR 44241 09/12/2025
No
  Total Approved 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 6,607 6,081 0 526 0 0
Annual Time Burden (Hours) 1,321 1,216 0 105 0 0
Annual Cost Burden (Dollars) 3,607 2,578 0 1,029 0 0
Yes
Miscellaneous Actions
No
EXPLANATION OF CHANGE TOTALS Respondents: The number of respondents (325) remain the same since we have the same number of Responsible Operators answering to this information collection. Responses: The number of responses increased from 6,081 to 6,607 due to increase in the number of forms received. Burden Hours: The number of burden hours increased from 1,216 to 1,321 due to increase in the number of responses. Costs: The annual burden costs increased from $2,578 to $3,607 due to the increase on postage.
$11,584
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.
09/12/2025