OMB control number
Request for State or Federal Workers' Compensation Information
OMB 1240-0032 · DOL/OWCP.
OMB 1240-0032
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 OWCP Form CM-905 requests the amount of those workers' compensation benefits.
The latest form for Request for State or Federal Workers' Compensation Information expires 2026-06-30 and can be found here.
Latest Forms, Documents, and Supporting Material
Request for State or Federal Workers' Compensation Information All Historical Document Collections
| Extension without change of a currently approved collection | 2026-03-11 | ||
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Approved without change |
Extension without change of a currently approved collection | 2023-05-25 | |
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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 | |
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Approved without change |
Revision of a currently approved collection | 2016-12-28 | |
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Approved without change |
Extension without change of a currently approved collection | 2013-10-24 | |
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Approved without change |
Revision of a currently approved collection | 2010-08-18 | |
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Approved without change |
Extension without change of a currently approved collection | 2010-03-12 |