Agency:

OWCP-DCMWC

Title:

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

Form Description:

To help determine continuing eligibility of primary beneficiaries receiving black lung benefits from the Black Lung Disability Trust Fund who also have representative payees, the CM-929p is completed by the representative payee to report factors that may affect the beneficiary's benefits, and to account for benefits received and expended on behalf of the beneficiary.

OMB Control Number:

1215-0084

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