Survivor’s Form For Benefits Under The Black Lung Benefits Act
Justification CM-912.docx
Survivor's Form for Benefits Under the Black Lung Benefits Act
SURVIVOR’S FORM FOR BENEFITS UNDER THE BLACK LUNG BENEFITS ACT
OMB: 1240-0027
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0027 can be found here:
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| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |