OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 1215-0052 · DOL/ESA.

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

All Historical Document Collections

200805-1215-006 Approved without change	Extension without change of a currently approved collection	2008-07-30
200506-1215-004 Approved without change	Extension without change of a currently approved collection	2005-06-20
200407-1215-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2004-07-10
200206-1215-005 Approved without change	Extension without change of a currently approved collection	2002-06-26
200203-1215-004 Withdrawn and continue	Extension without change of a currently approved collection	2002-03-29
199903-1215-004 Approved without change	Extension without change of a currently approved collection	1999-03-26
199602-1215-003 Approved without change	Extension without change of a currently approved collection	1996-02-29
199502-1215-001 Approved without change	Extension without change of a currently approved collection	1995-02-21
199112-1215-003 Approved without change	Revision of a currently approved collection	1991-12-31
198904-1215-001 Approved without change	Revision of a currently approved collection	1989-04-06
198605-1215-006 Approved without change	Revision of a currently approved collection	1986-05-29
198305-1215-001 Approved without change	Revision of a currently approved collection	1983-05-03
198107-1215-009 Approved with change	No material or nonsubstantive change to a currently approved collection	1981-07-17
197912-1215-002 Approved without change	Revision of a currently approved collection	1979-12-27
197807-1215-002 Approved without change	Revision of a currently approved collection	1978-07-25
197609-1215-003 Approved with change	No material or nonsubstantive change to a currently approved collection	1976-09-21