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Form CM-2017b Report of Claims Information for Self-Insured Operators
Application for Self-Insurance Under the Black Lung Benefits Act
cm-2017b NPRM
Application for Self-Insurance Under the Black Lung Benefits Act
OMB: 1240-0057
OMB.report
DOL/OWCP
OMB 1240-0057
ICR 202301-1240-004
IC 234819
Form CM-2017b Report of Claims Information for Self-Insured Operators
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0057 can be found here:
2025-01-15 - Revision of a currently approved collection
2024-01-31 - No material or nonsubstantive change to a currently approved collection
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