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Survivor's Form for Benefits Under the Black Lung Benefits Act
Survivor's Form for Benefits Under the Black Lung Benefits Act
OMB: 1240-0027
IC ID: 13721
OMB.report
DOL/OWCP
OMB 1240-0027
ICR 202304-1240-004
IC 13721
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0027 can be found here:
2024-03-13 - No material or nonsubstantive change to a currently approved collection
2024-01-31 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form CM-912
Survivor's Form for Benefits Under the Black Lung Benefits Act
Form
CM-912 Survivor's For for Benefits Under the Black Lung Benefits Act
New Form CM-912 Draft 04.20.2023.docx
dol.gov/owcp/regs/compliance/cm-912
Form
Information Collection (IC) Details
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