Authorization for Release of Medical Information

Authorization for Release of Medical Information for Black Lung Benefits

OMB: 1240-0034

IC ID: 13694

Documents and Forms

Document Name Document Type
Form CM-936 Authorization for Release of Medical Information Form
Form CM-936 Authorization for Release of Medical Information Form
CM-936 Authorization For Release of Medical Information (Black Lung Benefits) CM-936 Form.docx www.dol.gov/agencies/owcp/dcmwc/regs/compliance/blforms#black Form