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Supporting Statement 1240-0057 after comments
Supporting Statement 1240-0057 after comments.docx
Application for Self-Insurance Under the Black Lung Benefits Act
OMB: 1240-0057
OMB.report
DOL/OWCP
OMB 1240-0057
ICR 202401-1240-005
Supporting Statement 1240-0057 after comments
( Supporting Statement A )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0057 can be found here:
2025-01-15 - Revision of a currently approved collection
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