OMB control number
Disclosure of Medical Evidence
OMB 1240-0054 ยท DOL/OWCP.
OMB 1240-0054
The Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et seq., may require parties to exchange all medical information about the miner they develop in connection with a claim for benefits, including information parties do not intent to submit as evidence in the claim. BLBA regulations help protect a miner's health, assist unrepresented parties, and promote accurate benefit determinations. The potential parties to a BLBA claim include the benefits claimant, the responsible coal mine operator and its insurance carrier, and the Director of OWCP. Under BLBA, a party of a party's agent who receives medical information about the miner must send a copy to all other parties within 30 days after receipt or, if a hearing before an administrative law judge has already been scheduled, at least 20 days before the hearing. The exchanged information is entered into the record of the claim only if a party submits it into evidence.
The latest form for Disclosure of Medical Evidence expires 2028-07-31 and is listed under ICR 202502-1240-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
| Public Comments | |
| Supporting Statement A | |
| Information collection |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202502-1240-006 | Extension without change of a currently approved collection | 2025-06-04 | ||
| 202201-1240-002 | Extension without change of a currently approved collection | 2022-06-29 | Approved without change | |
| 201903-1240-004 | Extension without change of a currently approved collection | 2019-05-31 | Approved without change | |
| 201511-1240-003 | New collection (Request for a new OMB Control Number) | 2016-03-16 | Approved without change | |
| 201504-1240-002 | New collection (Request for a new OMB Control Number) | 2015-04-29 | Comment filed on proposed rule |