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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
OMB.report
DOL/OWCP
OMB 1240-0057
ICR 202301-1240-004
IC 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
Information Collection (IC) Details
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