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 ยท DOL/ESA.

OMB 1215-0052

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CM-911 1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment HistoryForm
1215-0052 Supporting Statement July 23 2008.docSupporting 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All Historical Document Collections

Historical document collections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200203-1215-004 Extension without change of a currently approved collection 2002-03-29 Withdrawn and continue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