The CM-912 is used to gather information from a beneficiary's survivor to determine if the survivor is entitled to benefits or the continuation of benefits.
The latest form for Survivor's Form for Benefits Under the Black Lung Benefits Act expires 2023-10-31 and can be found here.
Document Name |
---|
Form |
Form |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Supporting Statement A |
Supporting Statement A |
Justification for No Material/Nonsubstantive Change |
Justification for No Material/Nonsubstantive Change |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2024-03-13 | |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2024-01-31 | |
Approved without change |
Revision of a currently approved collection | 2023-09-07 | |
Approved without change |
Revision of a currently approved collection | 2020-03-27 | |
Approved without change |
Extension without change of a currently approved collection | 2016-12-28 | |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2015-10-26 | |
Approved without change |
Extension without change of a currently approved collection | 2013-10-25 | |
Approved without change |
Revision of a currently approved collection | 2010-08-18 | |
Approved without change |
Extension without change of a currently approved collection | 2010-03-12 |