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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
OMB.report
DOL/OWCP
OMB 1240-0034
ICR 202401-1240-009
Authorization For Release Of Medical Information For Black Lung Benefits
( Justification for No Material/Nonsubstantive Change )
⚠️ Notice: This form may be outdated.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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