Notice to Reviewer

Attachment 1-Notice to Reviewer CM-929 and CM-929P.docx

Report of Changes That May Affect Your Black Lung Benefits

Notice to Reviewer

OMB: 1240-0028

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NOTICE TO REVIEWER



Date: August 7, 2012

Request Type:  Non-substantive Change

Employing Agency:  Office of Workers’ Compensation Programs/Division of Coal Mine Workers’ Compensation (DCMWC)

Form Number/Name:  CM-929 and CM-929P, Report of Changes That May Affect Your Black Lung Benefits

OMB/Expiration Date:  1240-0028, September 30, 2014.

Justification:

DCMWC is seeking approval for the forms CM-929 and CM-929P.

Forms CM-929 and CM-929P are titled “Report of Changes That May Affect Your Black Lung Benefits” and require the same non-substantive change.  The CM-929 is mailed to the beneficiary for completion and the CM-929P is mailed to the beneficiaries Representative Payee for completion.  One minor change in Question 7 needs to be made, that being changing the age “65” to age “67”.  This is necessary due a changed SSA law – which DCMWC has yet to incorporate – describes a sliding scale that makes it possible for one’s full retirement age to be as high as 67 years old.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleNOTICE TO REVIEWER
AuthorUS Department of Labor
File Modified0000-00-00
File Created2021-01-30

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