CM-911a Employment History
Miner's Claim for Benefits Under the Black Lung Benefits Act CM-911 and Employment History CM-911a
CM-911a Form
1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment History
OMB: 1240-0038
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0038 can be found here: