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View ESA-OWCP-DCMWC's Form 1215-0171 Online 
| Agency: |
ESA-OWCP-DCMWC |
| Title: |
CM-972, Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The of Labor |
| Form Description: |
CM-972, Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor: The CM-972 is used by a claimant’s representative to request a fee for legal services performed in connection with a claim for black lung benefits. |
| OMB Control Number: |
1215-0171 |
| OMB Expiration Date: |
Friday, December 31, 2010
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