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

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 _Spanish-Final.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black 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