Wednesday, December 11, 2019

Sample legal forms and business documents

YOU ARE HERE Home Legal Forms Department of Labor (DOL) Office of Workers' Compensation Programs DCMWC (OWCP-DCMWC)

Office of Workers' Compensation Programs DCMWC (OWCP-DCMWC)

Form TitleCoverage
CM-1159, Report of Arterial Blood Gas Study All States
CM-2907, Report of Ventilatory Study All States
CM-2970, Operator Response to Schedule for Submission of Additional Evidence All States
CM-2970a, Operator Response to Notice of Claim All States
CM-623, Representative Payee Report All States
CM-623S, Representative Payee Report All States
CM-787, Physician's/Medical Officer's Statement All States
CM-893, Certificate of Medical Necessity All States
CM-908, Notice of Termination, Suspension, Reduction or Increase in Benefit Payments All States
CM-910, Request To Be Selected As Payee All States
CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act All States
CM-911a, Employment History All States
CM-912, Survivor's Form For Benefits Under The Black Lung Benefits Act All States
CM-913, Description Of Coal Mine Work and Other Employment All States
CM-921, Instructions For Completion of Form CM-921 All States
CM-929, Report of Changes That May Affect Your Black Lung Benefits All States
CM-933, Roentgenographic Interpretation All States
CM-933b, Roentgenographic Quality Rereading All States
CM-936, Authorization For Release Of Medical Information (Black Lung Benefits) All States
CM-972, Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The of Labor All States
CM-981, Certification by School Official All States
CM-988, Medical History and Examination for Coal Mine Workers' Pneumoconiosis All States
OWCP-1168, Black Lung Provider Enrollment Form All States