The CM-912 is used to gather information from a beneficiary's survivor to determine if the survivor is entitled to benefits or the continuation of benefits.
The latest form for Survivor's Form for Benefits Under the Black Lung Benefits Act expires 2023-10-31 and can be found here.
Document Name |
---|
Form |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Revision of a currently approved collection | 2023-09-07 | ||
Approved without change |
Revision of a currently approved collection | 2020-03-27 | |
Approved without change |
Extension without change of a currently approved collection | 2016-12-28 | |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2015-10-26 | |
Approved without change |
Extension without change of a currently approved collection | 2013-10-25 | |
Approved without change |
Revision of a currently approved collection | 2010-08-18 | |
Approved without change |
Extension without change of a currently approved collection | 2010-03-12 |