Form CM-936 Authorization for Release of Medical Information (Black Lung Benefits)

What Is Form CM-936?

This is a legal form that was released by the U.S. Department of Labor - Division of Coal Mine Workers' Compensation on March 1, 2022 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is CM-936?A: CM-936 is a form used to authorize the release of medical information for Black Lung Benefits.

Q: Who needs to fill out CM-936?A: Individuals who are applying for or receiving Black Lung Benefits and need to release their medical information.

Q: What is the purpose of CM-936?A: The purpose of CM-936 is to allow the release of medical information to the Department of Labor for the evaluation of Black Lung Benefits claims.

Q: What information is required in CM-936?A: CM-936 requires the individual's name, contact information, social security number, and a list of medical providers who have treated them for black lung-related conditions.