Agency:

OWCP-DCMWC

Title:

CM-929, Report of Changes That May Affect Your Black Lung Benefits

Form Description:

CM-929, Report of Changes That May Affect Your Black Lung Benefits: To help determine continuing eligibility of primary beneficiaries receiving black lung benefits from the Black Lung Disability Trust Fund, the CM-929 is completed by the beneficiary to report factors that may affect his or her benefits, including income, marital status, receipt of state workers' compensation, and dependents’ status.

OMB Control Number:

1215-0084

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