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Miner's Claim for Benefits Under the Black Lung Benefits Act and Employment History
OMB 1215-0052
OMB.report
DOL/ESA
OMB 1215-0052
OMB 1215-0052
Latest Forms, Documents, and Supporting Material
Document
Name
Form CM-911 1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment History
Form
1215-0052 Supporting Statement July 23 2008.doc
Supporting Statement A
20CFR725.304 - Forms and initial processing..pdf
Supplementary Document
DOL Privacy Act systems ESA-30.pdf
Supplementary Document
DOL Privacy Act systems ESA-6.pdf
Supplementary Document
20CFR725.404 - Development of evidence--general..pdf
Supplementary Document
1) Miner's Claim for Benefits Under the Black Lung Benefits Act; 2) Employment History
Form
All Historical Document Collections
200805-1215-006
Approved without change
Extension without change of a currently approved collection
2008-07-30
200506-1215-004
Approved without change
Extension without change of a currently approved collection
2005-06-20
200407-1215-004
Approved without change
No material or nonsubstantive change to a currently approved collection
2004-07-10
200206-1215-005
Approved without change
Extension without change of a currently approved collection
2002-06-26
200203-1215-004
Withdrawn and continue
Extension without change of a currently approved collection
2002-03-29
199903-1215-004
Approved without change
Extension without change of a currently approved collection
1999-03-26
199602-1215-003
Approved without change
Extension without change of a currently approved collection
1996-02-29
199502-1215-001
Approved without change
Extension without change of a currently approved collection
1995-02-21
199112-1215-003
Approved without change
Revision of a currently approved collection
1991-12-31
198904-1215-001
Approved without change
Revision of a currently approved collection
1989-04-06
198605-1215-006
Approved without change
Revision of a currently approved collection
1986-05-29
198305-1215-001
Approved without change
Revision of a currently approved collection
1983-05-03
198107-1215-009
Approved with change
No material or nonsubstantive change to a currently approved collection
1981-07-17
197912-1215-002
Approved without change
Revision of a currently approved collection
1979-12-27
197807-1215-002
Approved without change
Revision of a currently approved collection
1978-07-25
197609-1215-003
Approved with change
No material or nonsubstantive change to a currently approved collection
1976-09-21
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