DOL Form CM-910

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Submitted by workone on Sat, 2006-09-09 18:39. ::

DOL Form CM-910

View ESA-OWCP-DCMWC's Form 1215-0166 Online htm
Agency: ESA-OWCP-DCMWC
Title: CM-910, Request To Be Selected As Payee
Form Description: CM-910, Request To Be Selected As Payee: If a black lung beneficiary is incapable of handling his or her affairs, the person or institution responsible for the beneficiary’s care is required to apply to receive the benefit payments on the beneficiary's behalf. The CM 910 is the form completed by a person wanting to be appointed as representative payee.
OMB Control Number: 1215-0166
OMB Expiration Date: Tuesday, March 31, 2009

http://www.dol.gov/libraryforms/go-us-dol-form.asp?FormNumber=329&OMBNumber=1215-0166

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