Authorization For Release Of Medical Information For Black Lung Benefits

Justification CM-936.docx

Authorization for Release of Medical Information for Black Lung Benefits

AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION FOR BLACK LUNG BENEFITS

OMB: 1240-0034

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0034 can be found here:

2024-12-12 - Revision of a currently approved collection

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