Application for Self-Insurance Under the Black Lung Benefits Act

Application for Self-Insurance Under the Black Lung Benefits Act

OMB: 1240-0057

IC ID: 234819

Documents and Forms

Document Name Document Type
Form CM-2017b Application for Self-Insurance Under the Black Lung Benefits Act Form
CM-2017b Report of Claims Information for Self-Insured Operators cm-2017b NPRM.docx www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2017b.pdf Form
CM-2017 Application or Renewal of Self-Insurance Authority cm-2017 Application. NPRM.docx www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2017.pdf Form
InstructionsforApplyingorRenewingSelf-Insurance 1.10.23.docx www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2017.pdf Instruction