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

Notification Icon This version of the form is not currently in use and is provided for reference only. Download this version of Form CM-936 for the current year.

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 - Office of Workers' Compensation Programs on February 1, 2019 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form CM-936?
A: Form CM-936 is the Authorization for Release of Medical Information for Black Lung Benefits.

Q: What is the purpose of Form CM-936?
A: The purpose of Form CM-936 is to authorize the release of medical information for Black Lung Benefits.

Q: Who uses Form CM-936?
A: Form CM-936 is used by individuals applying for or receiving Black Lung Benefits.

Q: What information is required on Form CM-936?
A: Form CM-936 requires personal information of the individual, information about the person or entity authorized to release the medical information, and the specific information to be released.

Q: Are there any fees associated with submitting Form CM-936?
A: No, there are no fees associated with submitting Form CM-936.

Q: How long does it take to process Form CM-936?
A: The processing time for Form CM-936 can vary, but it is typically processed within a few weeks.

Q: Who can I contact for assistance with Form CM-936?
A: You can contact your local Black Lung Benefits office or the Department of Labor for assistance with Form CM-936.

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Form Details:

  • Released on February 1, 2019;
  • The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CM-936 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.

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

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