Print This Page
E-mail This PageDOL Form CM-929p
| Agency: | OWCP-DCMWC |
| Title: | CM-929p, Report of Changes That May Affect Your Black Lung Benefits |
| Form Description: | To help determine continuing eligibility of primary beneficiaries receiving black lung benefits from the Black Lung Disability Trust Fund who also have representative payees, the CM-929p is completed by the representative payee to report factors that may affect the beneficiary's benefits, and to account for benefits received and expended on behalf of the beneficiary. |
| OMB Control Number: | 1240-0028 |
 |
