Survivor's Form for Benefits Under the Black Lung Benefits Act
ICR 202401-1240-010
OMB: 1240-0027
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0027 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form |
Modified |
Form |
Modified |
Supporting Statement A | 2024-01-30 |
Supporting Statement A | 2024-01-30 |
Justification for No Material/Nonsubstantive Change | 2024-01-30 |
Justification for No Material/Nonsubstantive Change | 2024-01-30 |
Supplementary Document | 2020-03-03 |
Supplementary Document | 2020-03-03 |
Supplementary Document | 2020-03-03 |
Supplementary Document | 2020-03-03 |
Supplementary Document | 2019-11-26 |
Supplementary Document | 2019-11-26 |
Supplementary Document | 2019-11-26 |
Supplementary Document | 2019-11-26 |
Form CM-912 Survivor's Form for Benefits Under the Black Lung Benefits Act
SS 1240-0027 CM-912 2023_OCIO-Final.docx
DOL-OWCP-9.pdfIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 13721 | Modified | ||
| 13721 | Modified |
Survivor's Form for Benefits Under the Black Lung Benefits ActICR Details
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