Report of Changes That May Affect Your Black Lung Benefits

Report of Changes That May Affect Your Black Lung Benefits

OMB: 1240-0028

IC ID: 13756

Documents and Forms

Document Name Document Type
Form CM-929 Report of Changes That May Affect Your Black Lung Benefits Form
CM-929 Report of Changes That May Affect Your Black Lung Benefits 929 updated form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form
CM-929P Report of Changes That May Affect Your Black Lung Benefits 929P updated form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form