ICR Documents

Supporting Statement A Document Date Uploaded 1240-0038_Supporting Statement_DEIA 9.12.23_MN.docx 09/13/2023 Supporting Statement B Document Date Uploaded Supplementary Documents Title Document Document Type Date Uploaded 20 CFR 725.304 20CFR725.304 - Forms and initial processing.pdf Supplementary Document 08/08/2014 DOL/OWCP-2 System of Record Notice.pdf Supplementary Document 01/08/2018 20 CFR 725.404(a) 725.404.docx Supplementary Document 04/10/2018 NON- SUBSTANTIVE CHANGE REQUEST FOR THE MINER’S CLAIM for BENEFITS UNDER THE BLACK LUNG BENEFITS ACT CM-911 AND EMPLOYMENT HISTORY CM-911a OMB CONTROL NO. 1240-0038 (October 2023) Miners Application CM-911 Non-material change request_MN (002) sc.docx Justification for No Material/Nonsubstantive Change 11/07/2023 Public Comments Author Name Comment Document Author Affiliation Sponsoring Org. Type Category Date of Comment Date Comment Received