Description of Coal Mine Work and Other Employment

OMB 1240-0035

The Description of Coal Mine Work and Other Employment (Form CM-913) is used to compare non-coal mine work to coal mine work.

The latest form for Description of Coal Mine Work and Other Employment expires 2023-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CM-913 Description of Coal Mine Work and Other Employment Form
SS 1240-0035 CM-913 2023_OCIO1-MM.docx Supporting Statement A
DOL-OWCP-9.pdf Supplementary Document
DOL-OWCP-2.pdf Supplementary Document
725.405b.pdf Supplementary Document
20 CFR 718.204.doc Supplementary Document
Description of Coal Mine Work and Other Employment Form

All Historical Document Collections

202304-1240-006 Approved without change	Revision of a currently approved collection	2023-09-13
202003-1240-001 Approved without change	Revision of a currently approved collection	2020-06-09
201703-1240-002 Approved without change	Revision of a currently approved collection	2017-05-31
201312-1240-001 Approved without change	Revision of a currently approved collection	2014-03-28
201010-1240-001 Approved without change	Extension without change of a currently approved collection	2011-02-28
201003-1240-035 Approved without change	Revision of a currently approved collection	2010-03-12