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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
IC ID: 13721
OMB.report
DOL/OWCP
OMB 1240-0027
ICR 202401-1240-010
IC 13721
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1240-0027 can be found here:
2024-03-13 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form CM-912
Survivor's Form for Benefits Under the Black Lung Benefits Act
Form
Form CM-912
Survivor's Form for Benefits Under the Black Lung Benefits Act
Form
CM-912 Survivor's Form For Benefits Under The Black Lung Benefits Act
CM-912 Form.docx
www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black
Form
Information Collection (IC) Details
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