OMB control number
Certificate of Medical Necessity
OMB 1240-0024 ยท DOL/OWCP.
OMB 1240-0024
The Certificate of Medical Necessity is completed by the coal miner's doctor and is used by OWCP to determine if the miner meets impairment standards to qualify for durable medical equipment or home nursing.
The latest form for Certificate of Medical Necessity expires 2027-04-30 and is listed under ICR 202311-1240-006.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Form CM-893 Certificate of Medical Necessity | Form |
| SS 1240-0024 CM-893 2023 final.docx | Supporting Statement A |
| 20 CFR 725.707.pdf | Supplementary Document |
| 20 CFR 725.706.pdf | Supplementary Document |
| 20 CFR 725.705.pdf | Supplementary Document |
| 20 CFR 725.701.pdf | Supplementary Document |
| 30 USC Subchapter IV (Sections 901-951).pdf | Supplementary Document |
| System of Record Notice.pdf | Supplementary Document |
 Certificate of Medical Necessity |
Form |