OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Authorization for Release of Medical Information (Black Lung Benefits)

OMB 1215-0057 ยท DOL/ESA.

OMB 1215-0057

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CM-936 Authorization for Release of Medical InformationForm
ss 1215-0057 (CM-936) 7-07-09.docSupporting Statement A
725.405.pdf Supplementary Document
30 USC Sec. 902.pdf Supplementary Document
30 USC Sec. 901.pdf Supplementary Document
30 Chapter 22.pdf Supplementary Document
DOL-ESA-30.pdf Supplementary Document
DOL-ESA-6.pdf Supplementary Document
Authorization for Release of Medical Information Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
200903-1215-002 Extension without change of a currently approved collection 2009-08-24 Approved without change
200608-1215-004 Extension without change of a currently approved collection 2006-08-18 Approved with change
200309-1215-003 Extension without change of a currently approved collection 2003-09-26 Approved without change
200010-1215-001 Extension without change of a currently approved collection 2000-10-13 Approved without change
199710-1215-001 Extension without change of a currently approved collection 1997-10-23 Approved without change
199411-1215-002 Extension without change of a currently approved collection 1994-11-29 Approved without change
199111-1215-001 Extension without change of a currently approved collection 1991-11-08 Approved without change
198904-1215-018 No material or nonsubstantive change to a currently approved collection 1989-04-24 Approved with change
198904-1215-013 No material or nonsubstantive change to a currently approved collection 1989-04-10 Approved with change
198812-1215-001 Extension without change of a currently approved collection 1988-12-12 Approved without change
198603-1215-004 Extension without change of a currently approved collection 1986-03-13 Approved without change
198304-1215-001 Revision of a currently approved collection 1983-04-18 Approved without change
198206-1215-013 No material or nonsubstantive change to a currently approved collection 1982-06-30 Approved with change
197806-1215-014 Revision of a currently approved collection 1978-06-26 Approved without change
197806-1215-013 Revision of a currently approved collection 1978-06-26 Approved without change