Application for Self-Insurance Under the Black Lung Benefits Act

ICR 202401-1240-005

OMB: 1240-0057

Federal Form Document

Forms and Documents

Document Name	Status
Supporting Statement 1240-0057 after comments.docx Supporting Statement A	2024-01-30
Supporting Statement 1240-0057 after comments.docx Supporting Statement A	2024-01-30
Justification 1240-0057.docx Justification for No Material/Nonsubstantive Change	2024-01-30
Justification 1240-0057.docx Justification for No Material/Nonsubstantive Change	2024-01-30
Response to comments submitted to OIRA .8.10.22.docx Supplementary Document	2022-09-07
Response to comments submitted to OIRA .8.10.22.docx Supplementary Document	2022-09-07

IC Document Collections

IC ID	Document Title	Status
234819	Application for Self-Insurance Under the black Lung Benefits Act Instruction	Modified