Black Lung Consent Form
Consent Form_ Black Lung.docx
Improving Customer Experience (OMB Circular A-11, Section 280 Implementation) for the Department of Labor (DOL)
Black Lung Consent Form
OMB: 1225-0093
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1225-0093 can be found here: