Agency:

OWCP-DCMWC

Title:

CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act

Form Description:

CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act: A miner who applies for black lung benefits must complete the CM 911 (application form). A local Social Security office or Black Lung district office can help in the completion of this form.

OMB Control Number:

1215-0052

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