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Application For Self-insurance Under The Black Lung Benefits Act
Justification 1240-0057.docx
Application for Self-Insurance Under the Black Lung Benefits Act
APPLICATION FOR SELF-INSURANCE UNDER THE BLACK LUNG BENEFITS ACT
OMB: 1240-0057
OMB.report
DOL/OWCP
OMB 1240-0057
ICR 202401-1240-005
Application For Self-insurance Under The Black Lung Benefits Act
( Justification for No Material/Nonsubstantive Change )
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