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This version of the form is not currently in use and is provided for reference only. Download this version of
Form CM-911
for the current year.
Form CM-911 Miner's Claim for Benefits Under the Black Lung Benefits Act
What Is Form CM-911?
This is a legal form that was released by the U.S. Department of Labor on March 1, 2019 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form CM-911?
A: Form CM-911 is a Miner's Claim for Benefits Under the Black Lung Benefits Act.
Q: What does the Black Lung Benefits Act provide?
A: The Black Lung Benefits Act provides benefits to miners who have been diagnosed with black lung disease.
Q: Who is eligible to file Form CM-911?
A: Miners who have been diagnosed with black lung disease and their dependents are eligible to file Form CM-911.
Q: What information is required on Form CM-911?
A: Form CM-911 requires information about the miner's employment history, medical diagnosis, and dependent information.
Q: Is there a deadline for filing Form CM-911?
A: Yes, there is a deadline for filing Form CM-911. It must be filed within three years of the date of the miner's death or of the last exposure to coal dust.
Form Details:
- Released on March 1, 2019;
- The latest available edition released by the U.S. Department of Labor;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form CM-911 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor.
Download Form CM-911 Miner's Claim for Benefits Under the Black Lung Benefits Act
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