Form CM-911 Miner's Claim for Benefits Under the Black Lung Benefits Act

Form CM-911 Miner's Claim for Benefits Under the Black Lung Benefits Act

What Is Form CM-911?

This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on April 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 Form CM-911?
A: Form CM-911 is a document used to claim benefits under the Black Lung Benefits Act.

Q: Who can use Form CM-911?
A: Miners who suffer from black lung disease can use Form CM-911 to claim benefits.

Q: What is the Black Lung Benefits Act?
A: The Black Lung Benefits Act is a federal law that provides compensation and benefits to coal miners who have developed black lung disease.

Q: What information is required on Form CM-911?
A: Form CM-911 requires information such as the miner's personal details, employment history, medical information, and supporting documentation.

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Form Details:

  • Released on April 1, 2022;
  • 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;

Download a fillable version of Form CM-911 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-911 Miner's Claim for Benefits Under the Black Lung Benefits Act

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