OMB control number
Authorization for Release of Medical Information for Black Lung Benefits
OMB 1240-0034 · DOL/OWCP.
OMB 1240-0034
OWCP Form 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.
The latest form for Authorization for Release of Medical Information for Black Lung Benefits expires 2028-01-31 and can be found here.
Latest Forms, Documents, and Supporting Material
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Form |
Supporting Statement A |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Supplementary Document |
Form CM-936 Authorization for Release of Medical Information
System of Record Notice-DOL OWCP-2.pdf
Authorization for Release of Medical Information All Historical Document Collections
| Revision of a currently approved collection | 2024-12-12 | ||
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2024-01-31 | |
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Approved without change |
Extension without change of a currently approved collection | 2022-01-20 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2020-10-23 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2020-04-12 | |
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Approved without change |
Revision of a currently approved collection | 2018-11-30 | |
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Approved without change |
No material or nonsubstantive change to a currently approved collection | 2016-03-14 | |
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Approved without change |
Revision of a currently approved collection | 2015-08-18 | |
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Approved without change |
Revision of a currently approved collection | 2012-09-14 | |
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Approved without change |
Extension without change of a currently approved collection | 2010-03-12 |