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View ESA-OWCP-DCMWC's Form 1215-0090 Online 
| Agency: |
ESA-OWCP-DCMWC |
| Title: |
CM-1159, Report of Arterial Blood Gas Study |
| Form Description: |
CM-1159, Report of Arterial Blood Gas Study: After a coal miner applies for black lung benefits, a complete pulmonary evaluation is authorized in order to determine if the claimant is totally disabled by pneumoconiosis. The arterial blood gas study is one part of the evaluation. The CM-1159 is completed by the physician. |
| OMB Control Number: |
1215-0090 |
| OMB Expiration Date: |
Wednesday, August 31, 2011
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