OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Request to be Selected as Payee

OMB 1240-0010 ยท DOL/OWCP.

OMB 1240-0010

The CM-910 is used to obtain information about prospective representative payees to determine whether they are qualified to handle monetary benefits on behalf of a beneficiary under Part 901 of the Black Lung Benefits Act.

The latest form for Request to be Selected as Payee expires 2027-09-30 and is listed under ICR 202601-1240-003.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CM-910 Request To Be Selected As PayeeForm
Form CM-910 Request to be selected as PayeeForm
Form CM-910 Request To Be Selected As PayeeForm
Form CM-910 Request To Be Selected As PayeeForm
Form CM-910 Request to be Selected as PayeeForm
1240-0010 Request to Be Selected As Rep Payee (CM-910) proposed change-Form 012026.docxSupplementary Document
Non-Sub Justification 910 2026.docxJustification for No Material/Nonsubstantive Change
Non-Sub Justification 910 2026.docx Justification for No Material/Nonsubstantive Change
Supporting Statement 1240-0010 Final.docxSupporting Statement A
Supporting Statement 1240-0010 Final.docxSupporting Statement A
DOL_OWCP-9 _ U.S. Department of Labor.pdfSupplementary Document
System of Record Notice-DOL OWCP-2.pdfSupplementary Document
20 CFR 725.505-513 for 1215-0166.pdfSupplementary Document
Request to be Selected as Payee Form
Request to be Selected as Payee Form
Request to be Selected as Payee Form
Request to be Selected as Payee Form
Request to be Selected as Payee Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202601-1240-003 No material or nonsubstantive change to a currently approved collection 2026-01-12 Approved without change
202508-1240-001 No material or nonsubstantive change to a currently approved collection 2025-08-12
202411-1240-001 No material or nonsubstantive change to a currently approved collection 2024-12-03 Approved without change
202404-1240-001 Extension without change of a currently approved collection 2024-07-31 Approved without change
202107-1240-001 Extension without change of a currently approved collection 2021-08-30 Approved without change
201803-1240-004 Revision of a currently approved collection 2018-06-29 Approved without change
201602-1240-002 No material or nonsubstantive change to a currently approved collection 2016-03-14 Approved without change
201412-1240-001 Revision of a currently approved collection 2015-04-01 Approved without change
201201-1240-001 Extension without change of a currently approved collection 2012-03-29 Approved without change
201003-1240-010 Extension without change of a currently approved collection 2010-03-12 Approved without change