Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments

OMB 1240-0030

Requesting address change for CM-908. Coal mine operators who pay monthly benefits must notify the Department's Division of Coal Mine Workers' Compensation (DCMWC) of any change in payments and the reason for that change. DCMWC uses this notification to monitor payments and ensure that beneficiaries receive the correct benefit rate.

The latest form for Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments expires 2022-01-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form CM-908 Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form
Form CM-908 Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form
Supporting Statement 1240-0030 CM-908 10.17.22 MM.docx Supporting Statement A
Supporting Statement 1240-0030 CM-908 10.17.22 MM.docx Supporting Statement A
Justification 908.docx Justification for No Material/Nonsubstantive Change
Justification 908.docx Justification for No Material/Nonsubstantive Change
System of Record Notice-DOL OWCP-2.pdf Supplementary Document
System of Record Notice-DOL OWCP-2.pdf Supplementary Document
20 CFR 725.621.pdf Supplementary Document
20 CFR 725.621.pdf Supplementary Document
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments Form

All Historical Document Collections

202401-1240-002 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-01-31
202205-1240-002 Approved without change	Revision of a currently approved collection	2022-10-21
202110-1240-002 Approved without change	Revision of a currently approved collection	2021-12-23
202008-1240-043 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-10-20
202002-1240-011 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-02-21
201807-1240-002 Approved without change	Revision of a currently approved collection	2018-08-31
201502-1240-002 Approved without change	Revision of a currently approved collection	2015-06-03
201205-1240-001 Approved without change	Revision of a currently approved collection	2012-06-19
201003-1240-030 Approved without change	Extension without change of a currently approved collection	2010-03-12