Application for Self-Insurance Under the Black Lung Benefits Act
ICR 202301-1240-004
OMB: 1240-0057
Federal Form Document
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 1240-0057 can be found here:
Forms and Documents
Document Name | Status |
|---|---|
Form |
Modified |
Supporting Statement A | 2023-01-18 |
Form CM-2017b Application for Self-Insurance Under the Black Lung Benefits Act
Supporting Statement 1240-0057 - Final-OCIO (2)MM.docxIC Document Collections
| IC ID | Document Title | Status | |
|---|---|---|---|
| 234819 | Modified |
Application for Self-Insurance Under the Black Lung Benefits ActICR Details
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