|
View ESA-OWCP-DCMWC's Form 1215-0052 Online 
| Agency: |
ESA-OWCP-DCMWC |
| Title: |
CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act |
| Form Description: |
CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act: A miner who applies for black lung benefits must complete the CM 911 (application form). A local Social Security office or Black Lung district office can help in the completion of this form. |
| OMB Control Number: |
1215-0052 |
| OMB Expiration Date: |
Friday, September 30, 2011
|
| |
|
