Notice to Reviewer

NOTE TO REVIEWER_20160314.docx

Authorization for Release of Medical Information for Black Lung Benefits

Notice to Reviewer

OMB: 1240-0034

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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 Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorThurston, Debra - OWCP
File Modified0000-00-00
File Created2021-01-20

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