MINER’S CLAIM for BENEFITS UNDER THE BLACK LUNG BENEFITS ACT CM-911 AND EMPLOYMENT HISTORY CM-911a

Justification CM-911 & CM-911a.docx

Miner's Claim for Benefits Under the Black Lung Benefits Act CM-911 and Employment History CM-911a

MINER’S CLAIM for BENEFITS UNDER THE BLACK LUNG BENEFITS ACT CM-911 AND EMPLOYMENT HISTORY CM-911a

OMB: 1240-0038