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SS 1240-0028 929's 2024_MN-MM (002)_MN-MM-RB
SS 1240-0028 929's 2024_MN-MM (002)_MN-MM-RB.docx
Report of Changes That May Affect Your Black Lung Benefits
OMB: 1240-0028
OMB.report
DOL/OWCP
OMB 1240-0028
ICR 202311-1240-005
SS 1240-0028 929's 2024_MN-MM (002)_MN-MM-RB
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0028 can be found here:
2024-07-17 - No material or nonsubstantive change to a currently approved collection
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