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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-936
for the current year.
Form CM-936 Authorization for Release of Medical Information (Black Lung Benefits)
What Is Form CM-936?
This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on February 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-936?
A: Form CM-936 is the Authorization for Release of Medical Information for Black Lung Benefits.
Q: What is the purpose of Form CM-936?
A: The purpose of Form CM-936 is to authorize the release of medical information for Black Lung Benefits.
Q: Who uses Form CM-936?
A: Form CM-936 is used by individuals applying for or receiving Black Lung Benefits.
Q: What information is required on Form CM-936?
A: Form CM-936 requires personal information of the individual, information about the person or entity authorized to release the medical information, and the specific information to be released.
Q: Are there any fees associated with submitting Form CM-936?
A: No, there are no fees associated with submitting Form CM-936.
Q: How long does it take to process Form CM-936?
A: The processing time for Form CM-936 can vary, but it is typically processed within a few weeks.
Q: Who can I contact for assistance with Form CM-936?
A: You can contact your local Black Lung Benefits office or the Department of Labor for assistance with Form CM-936.
Form Details:
- Released on February 1, 2019;
- The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
- 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-936 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.
Download Form CM-936 Authorization for Release of Medical Information (Black Lung Benefits)
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