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May 8, 2009   
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DOL Form CM-972

View ESA-OWCP-DCMWC's Form CM-972 Online htm
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

 

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