Information Collection Request

Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor

ICR 202401-1240-007 · OMB 1240-0011 · Active

Forms and Documents

Forms and supporting documents for this ICR
Document	Type	Status	Availability
Form CM-972 Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor	Form	Modified	Available
Form CM-972 Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor	Form	Modified	Repair queued
SS 1240-0011 CM-972_2023_OCIO MM.docx	Supporting Statement A	Uploaded 2024-01-30	Available
SS 1240-0011 CM-972_2023_OCIO MM.docx	Supporting Statement A	Uploaded 2024-01-30	Repair queued
Justification CM-972.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-01-30	Available
Justification CM-972.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-01-30	Repair queued
DOL-OWCP-2, Office of Workers' Compensation, Black Lung Benefits Claim File.pdf	Supplementary Document	Uploaded 2017-02-22	Available
DOL-OWCP-2, Office of Workers' Compensation, Black Lung Benefits Claim File.pdf	Supplementary Document	Uploaded 2017-02-22	Repair queued

Information collection document groups
IC ID	Collection	Type	Status	Form
13877	Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor	Form	Modified
13877	Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor	Form	Modified

Record metadata
Status	Active
Agency/Subagency	DOL/OWCP
OMB Control No	1240-0011
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202304-1240-002
Date Submitted to OIRA	2024-01-31
Requested Expiration Date	1969-12-31