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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
OMB.report
DOL/OWCP
OMB 1240-0038
ICR 202401-1240-012
IC 13681
CM-911a Employment History
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0038 can be found here:
2024-03-13 - No material or nonsubstantive change to a currently approved collection
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