Forms Catalog Document - CM936 :-: ESA :-: Authorization for Release of Medical Information (Black Lung Benefits)

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Authorization for Release of Medical Information (Black Lung Benefits)

Authorization for Release of Medical Information The CM-936 is used to obtain the black lung claimant's authorization for the Division of Coal Mine Workers' Compensation to request medical evidence in support of the black lung claim.

Form #: CM 936
Agency: Department of Labor
Bureau: Employment Standards Administration
Common Name: CM-936

	TYPE	PAGES	SIZE (KB)	CAPABILITY	WHAT'S NEEDED
	Form Only	1		[4] Fillable + Fileable	Adobe Reader Download

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