NOTICE TO REVIEWER
Date: July 1, 2013
Request Type: Non-substantial 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 28, 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 similar non-substantive changes to their Instruction Pages. The CM-929 is mailed to the beneficiary for completion and the CM-929P is mailed to the Representative Payee of the beneficiary for completion.
This is necessary due to incorrect language that references where to look for the District Offices toll-free phone numbers and listing our eight remaining District Offices. The Wilkes-Barre, Pennsylvania was closed several months ago.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Debra Thurston |
| File Modified | 0000-00-00 |
| File Created | 2021-01-29 |