Forms Catalog Document - CM929 :-: ESA :-: Report of Changes That May Affect Your Black Lung Benefits

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Report of Changes That May Affect Your Black Lung Benefits

To help determine continuing eligibility of primary beneficiaries receiving black lung benefits from the Disability Trust Fund. To verify and update on a regular basis factors that affect a beneficiary's entitlement to benefits, including income, marital status, receipt of State Worker's Compensation, and dependent status.

Form #: CM 929
Agency: Department of Labor
Bureau: Employment Standards Administration
Common Name: Report of Changes That May Affect Your Black Lung Benefits

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Form Only	2		[3] Fillable + Printable	Adobe Reader Download

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