OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor

OMB 1240-0011 · DOL/OWCP.

OMB 1240-0011

The purpose of the CM-972 is to collect pertinent data to determine if the representative's services and the amounts charged can be paid under the Black Lung Benefits Act.

The latest form for Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor expires 2026-10-31 and can be found here.

Latest Forms, Documents, and Supporting Material
Document
Name
Form
Form
Supporting Statement A
Supporting Statement A
Justification for No Material/Nonsubstantive Change
Justification for No Material/Nonsubstantive Change
Supplementary Document
Supplementary Document
All Historical Document Collections
Approved without change
 No material or nonsubstantive change to a currently approved collection 2024-01-31
Approved with change
 Revision of a currently approved collection 2023-09-07
Approved without change
 Extension without change of a currently approved collection 2020-05-12
Approved without change
 Extension without change of a currently approved collection 2017-03-07
Approved without change
 Revision of a currently approved collection 2014-01-30
Approved without change
 Extension without change of a currently approved collection 2010-12-22
Approved without change
 No material or nonsubstantive change to a currently approved collection 2010-03-12