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Supporting Statement 1240-0057 - Final-OCIO (2)MM
Supporting Statement 1240-0057 - Final-OCIO (2)MM.docx
Application for Self-Insurance Under the Black Lung Benefits Act
OMB: 1240-0057
OMB.report
DOL/OWCP
OMB 1240-0057
ICR 202301-1240-004
Supporting Statement 1240-0057 - Final-OCIO (2)MM
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0057 can be found here:
2024-01-31 - No material or nonsubstantive change to a currently approved collection
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