OWCP is requesting an address change to the Request for State or Federal Workers' Compensation Information (CM-905). DCMWC beneficiaries have their monthly benefits reduced dollar for dollar for other benefits that they receive attributable to their black lung disability from State or Federal workers' benefits. The CM-905 request the amount of those workers' compensation benefits.
The latest form for Request for State or Federal Workers' Compensation Information expires 2023-07-31 and can be found here.
Document Name |
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Form |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Approved without change |
Extension without change of a currently approved collection | 2023-05-25 | |
Approved without change |
No material or nonsubstantive change to a currently approved collection | 2020-10-21 | |
Approved without change |
Revision of a currently approved collection | 2020-02-27 | |
Approved without change |
Revision of a currently approved collection | 2016-12-28 | |
Approved without change |
Extension without change of a currently approved collection | 2013-10-24 | |
Approved without change |
Revision of a currently approved collection | 2010-08-18 | |
Approved without change |
Extension without change of a currently approved collection | 2010-03-12 |