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FEDERAL
Administrative
Survivor's Form For Benefits Under The Black Lung Benefits Act
US Dept. of Labor — Forms
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FEDERAL
Administrative
Stipulation Approval Request
US Dept. of Labor — Forms
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FEDERAL
Administrative
Statement of Recovery Letter with Short Form
US Dept. of Labor — Forms
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FEDERAL
Administrative
Statement of Recovery Letter with Long Form
US Dept. of Labor — Forms
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FEDERAL
Administrative
Settlement Judge Request
US Dept. of Labor — Forms
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FEDERAL
Administrative
Roentgenographic Quality Rereading
US Dept. of Labor — Forms
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FEDERAL
Administrative
Settlement Approval Request Section 8(i)
US Dept. of Labor — Forms
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FEDERAL
Administrative
Roentgenographic Interpretation
US Dept. of Labor — Forms
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PDF
Survivor's Form For Benefits Under The Black Lung Benefits Act
PDF
Stipulation Approval Request
PDF
Statement of Recovery Letter with Short Form
PDF
Statement of Recovery Letter with Long Form
PDF
Settlement Judge Request
PDF
Roentgenographic Quality Rereading
PDF
Settlement Approval Request Section 8(i)
PDF
Roentgenographic Interpretation
PDF
Request To Be Selected As Payee
PDF
Request for Intervention
PDF
Request for Examination and/or Treatment
PDF
Request for Earnings Information
PDF
Representative Payee Report
PDF
Request for Appointment of Mediator
PDF
Representative Payee Report
PDF
Report of Ventilatory Study
PDF
Report of Payments.
PDF
Report of Injury Experience of Insurance Carrier or Self-Insured Employer
PDF
Report of Changes That May Affect Your Black Lung Benefits
PDF
Report of Earnings
PDF
Report of Arterial Blood Gas Study
PDF
Report of Changes That May Affect Your Black Lung Benefits
PDF
Rehabilitation Maintenance Certificate
PDF
Rehabilitation Plan And Award
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