OMB control number
Disclosure of Medical Evidence
OMB 1240-0054 · DOL/OWCP.
The Black Lung Benefits Act (BLBA), 30 U.S.C. 901 et seq., may require parties to exchange all medical information about the miner they develop in connection with a claim for benefits, including information parties do not intent to submit as evidence in the claim. BLBA regulations help protect a miner's health, assist unrepresented parties, and promote accurate benefit determinations. The potential parties to a BLBA claim include the benefits claimant, the responsible coal mine operator and its insurance carrier, and the Director of OWCP. Under BLBA, a party of a party's agent who receives medical information about the miner must send a copy to all other parties within 30 days after receipt or, if a hearing before an administrative law judge has already been scheduled, at least 20 days before the hearing. The exchanged information is entered into the record of the claim only if a party submits it into evidence.
The latest form for Disclosure of Medical Evidence expires 2028-07-31 and can be found here.
Document Name |
|---|
Supporting Statement A |
| Extension without change of a currently approved collection | 2025-06-04 | ||
|
Approved without change |
Extension without change of a currently approved collection | 2022-06-29 | |
|
Approved without change |
Extension without change of a currently approved collection | 2019-05-31 | |
|
Approved without change |
New collection (Request for a new OMB Control Number) | 2016-03-16 | |
|
Comment filed on proposed rule |
New collection (Request for a new OMB Control Number) | 2015-04-29 |