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Form CM-912 Survivor's Form For Benefits Under The Black Lung Benefi
Survivor's Form for Benefits Under the Black Lung Benefits Act
CM-912 Form
Survivor's Form for Benefits Under the Black Lung Benefits Act
OMB: 1240-0027
OMB.report
DOL/OWCP
OMB 1240-0027
ICR 202401-1240-010
IC 13721
Form CM-912 Survivor's Form For Benefits Under The Black Lung Benefi
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1240-0027 can be found here:
2024-03-13 - No material or nonsubstantive change to a currently approved collection
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