NOTICE TO REVIEWER
Date: February 11, 2016
Request Type: No material or non-substantive change to a currently approved collection
Employing Agency: Office of Workers’ Compensation Programs/Division of Coal Mine Workers’ Compensation (DCMWC)
Form Number/Name: CM-936, Authorization For Release of Medical Information
OMB/Expiration Date: 1240-0034, November 30, 2018
Justification:
Item 9. is being updated to read:
“Signature of Claimant (or person on his/her behalf)”
The “/her” was added, since the claimant could be male or female.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Thurston, Debra - OWCP |
| File Modified | 0000-00-00 |
| File Created | 2021-01-24 |