NOTICE TO REVIEWER
Date: February 11, 2016
Request Type: No material or non-substantive change to a currently approved collection
Employing Agency: Office of Workers’ Compensation Programs/Division of Coal Mine Workers’ Compensation (DCMWC)
Form Number/Name: CM-911, Miner’s Claim For Benefits Under The Black Lung Benefits Act
OMB/Expiration Date: 1240-0038, January 31, 2018
Justification: Typographical changes are being made to Question 10i so it reads:
“If you have received a lump-sum payment based on your compensation claim, please indicate the following:”
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Thurston, Debra - OWCP |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |