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Form CM-921 Report of Coverage for Policies of Insurance Under the Black Lung Benefits Act
What Is Form CM-921?
This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on September 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-921?A: Form CM-921 is a report of coverage for policies of insurance under the Black Lung Benefits Act.
Q: Who is required to file Form CM-921?A: Employers who provide coverage for black lung benefits under the Black Lung Benefits Act are required to file Form CM-921.
Q: What information is required in Form CM-921?A: Form CM-921 requires information such as the employer's name, address, policy number, and the total amount of black lung benefits provided.
Q: When should Form CM-921 be filed?A: Form CM-921 should be filed annually, within 30 days after the end of the calendar year.
Form Details:
- Released on September 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 printable version of Form CM-921 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-921 Report of Coverage for Policies of Insurance Under the Black Lung Benefits Act
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