Official Federal Forms > US Dept Of Labor
Operator Response To Notice Of Claim CM-2970a - Official Federal Forms
| Operator Response To Notice Of Claim Form. This is a national form and can be used in US Dept Of Labor . |
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Operator Response To Notice of Claim 0LQHU V 1DPH 3RWHQWLDOO\ /LDEOH 2SHUDWRU V 1DPH 2IILFH RI :RUNHUV &RPSHQVDWLRQ 3URJUDPV 'LYLVLRQ RI &RDO 0LQH :RUNHUV &RPSHQVDWLRQ &ODLPDQW V 1DPH ,QVXUHU V 1DPH &ODLP 1XPEHU 20% 1R ([SLUHV 3ROLF\ 1R U.S. Department of Labor This information is authorized by the Black Lung Benefits Act (30 U.S. C. 901 et seq.) (20 CFR 725.408). Please check appropriate boxes and provide requested information. While you are not required to respond, if you fail to do so within 30 days of your receipt of the Notice of Claim you shall not be allowed to contest your liability for the payment of benefits on any of the five specific grounds set forth below in Section B. (20 CFR 725.408). Link/Embed this Document |
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