Miner's Claim for Benefits Under the Black Lung Benefits Act and Employment History

OMB 1215-0052

Latest Forms, Documents, and Supporting Material

Document Name
Form CM-911 1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment History Form
1215-0052 Supporting Statement July 23 2008.doc Supporting Statement A
20CFR725.304 - Forms and initial processing..pdf Supplementary Document
DOL Privacy Act systems ESA-30.pdf Supplementary Document
DOL Privacy Act systems ESA-6.pdf Supplementary Document
20CFR725.404 - Development of evidence--general..pdf Supplementary Document
1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment History Form