Office of Workers' Compensation Programs (OWCP)

Printer-Friendly Version

Division of Coal Mine Workers' Compensation (DCMWC)

On This Page DCMWC Forms Print Form Option Form-Fill Option Electronic Fill/Submit Option Black Lung Forms

DCMWC Forms

OWCP’s Division of Coal Mine Workers' Compensation has made a variety of forms available online. These forms are only available in PDF format. In order to view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version (click on Adobe Acrobat Reader to download the current version) available on your workstation.

The forms in the list below may be completed manually via the print form option or electronically via the electronic fill/submit option:

Print Form Option

Most of DCMWC’s forms are available online to print and to manually fill and submit. Simply click on the appropriate form and print it using the [Print] button provided near the top of the form. Write or type the required information on the hardcopy and authorize the form, if applicable, with a hand-written signature. Then mail the completed form to the DCMWC office you normally send to for this process.

Form-Fill Option

Simply click on the appropriate form, fill out the form using your computer keyboard and the <TAB> key or your mouse to navigate between form fields. Print the form (use the Print button on or near the top of the form), authorize the form (if applicable provide hand-written signature) and mail the completed form to the DCMWC office you normally send to for this process.

Electronic Fill/Submit Option

Select DCMWC forms, noted with an asterisk (*) on the list of forms below, may be electronically filled and submitted to OWCP/DCMWC. To do so, you must have Adobe Reader 6.x installed on your PC.

To electronically submit a DCMWC form, follow these simple steps:

1. Obtain an electronic signature from IdenTrust Inc. Upon opening the form, if you don't already have a digital signature on your PC, you will be directed to the IdenTrust Inc. website to obtain an electronic signature. The entire process of obtaining the electronic signature will take 5-10 business days. (You only have to do this one time. Thereafter, you will use the same signature.) Note: Adobe 6.x is required to apply a digital signature
   
2. Fill out the form completely. It is recommended that you print the form prior to submitting, and keep the hardcopy for your records. To do so, use the [Print] button provided near the top of the form.
3. Click on the [Submit] button near the top of the form. A message will appear noting that the form has been received and will provide an identification number. It is recommended that you record the ID number on your hardcopy.
4. If you have questions about filling/submitting these forms or need other forms assistance, you can send DCMWC a question via e-mail. DCMWC will respond to your question via e-mail.

NOTE: When printing these files please remember to use the Adobe Acrobat Reader print icon or the [Print] button on the form, itself, and NOT your browser's print icon on the browser toolbar.

Black Lung Forms