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Application for Benefits Under The Federal Mine Safety and Health Act of 1977, as Amended (Widow's Claim, Child's Claim and Dependent's Claim
Application for Benefits Under The Federal Mine Safety and Health Act of 1977, as Amended (Widow's Claim, Child's Claim and Dependent's Claim
OMB: 0960-0118
IC ID: 9090
OMB.report
SSA
OMB 0960-0118
ICR 200102-0960-009
IC 9090
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0960-0118 can be found here:
2001-09-25 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Application for Benefits Under The Federal Mine Safety and Health Act of 1977, as Amended (Widow's Claim, Child's Claim and Dependent's Claim
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
SSA-48-F4
No
No
Form
SSA-47-F4
No
No
Form
SSA-49-F3
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,800
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
1,800
0
0
0
0
1,800
Annual IC Time Burden (Hours)
330
0
0
0
0
330
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.