OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor

OMB 1240-0011 · DOL/OWCP.

OMB 1240-0011

The purpose of the CM-972 is to collect pertinent data to determine if the representative's services and the amounts charged can be paid under the Black Lung Benefits Act.

The latest form for Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor expires 2026-10-31 and is listed under ICR 202401-1240-007.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form CM-972 Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of LaborForm
Form CM-972 Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of LaborForm
SS 1240-0011 CM-972_2023_OCIO MM.docxSupporting Statement A
SS 1240-0011 CM-972_2023_OCIO MM.docxSupporting Statement A
Justification CM-972.docx Justification for No Material/Nonsubstantive Change
Justification CM-972.docx Justification for No Material/Nonsubstantive Change
DOL-OWCP-2, Office of Workers' Compensation, Black Lung Benefits Claim File.pdf Supplementary Document
DOL-OWCP-2, Office of Workers' Compensation, Black Lung Benefits Claim File.pdf Supplementary Document
Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor Form
Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202401-1240-007 No material or nonsubstantive change to a currently approved collection 2024-01-31 Approved without change
202304-1240-002 Revision of a currently approved collection 2023-09-07 Approved with change
202001-1240-001 Extension without change of a currently approved collection 2020-05-12 Approved without change
201611-1240-001 Extension without change of a currently approved collection 2017-03-07 Approved without change
201309-1240-002 Revision of a currently approved collection 2014-01-30 Approved without change
201011-1240-001 Extension without change of a currently approved collection 2010-12-22 Approved without change
201003-1240-011 No material or nonsubstantive change to a currently approved collection 2010-03-12 Approved without change