OMB control number
Request to be Selected as Payee
OMB 1240-0010 · DOL/OWCP.
OMB 1240-0010
The CM-910 is used to obtain information about prospective representative payees to determine whether they are qualified to handle monetary benefits on behalf of a beneficiary under Part 901 of the Black Lung Benefits Act.
The latest form for Request to be Selected as Payee expires 2027-09-30 and can be found here.
Latest Forms, Documents, and Supporting Material
Document Name |
|---|
Form |
Supplementary Document |
Justification for No Material/Nonsubstantive Change |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Form CM-910 Request to be Selected as Payee
1240-0010 Request to Be Selected As Rep Payee (CM-910) proposed change-Form 012026.docx
DOL_OWCP-9 _ U.S. Department of Labor.pdf
Request to be Selected as Payee All Historical Document Collections
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2026-01-12 | |
| No material or nonsubstantive change to a currently approved collection | 2025-08-12 | ||
|
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2024-12-03 | |
|
Approved without change |
Extension without change of a currently approved collection | 2024-07-31 | |
|
Approved without change |
Extension without change of a currently approved collection | 2021-08-30 | |
|
Approved without change |
Revision of a currently approved collection | 2018-06-29 | |
|
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2016-03-14 | |
|
Approved without change |
Revision of a currently approved collection | 2015-04-01 | |
|
Approved without change |
Extension without change of a currently approved collection | 2012-03-29 | |
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Approved without change |
Extension without change of a currently approved collection | 2010-03-12 |