CM-911a Employment History

Miner's Claim for Benefits Under the Black Lung Benefits Act CM-911 and Employment History CM-911a

CM-911a final

OMB: 1240-0038

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0038 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

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