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CM-936 Authorization for Release of Medical Records – Fillable PDF

  1. Language English
  2. Country USA
  3. Department Department of Labor
  4. Agency Office of Workers' Compensation Programs
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CM-936 Authorization for Release of Medical Records – Fillable PDF

The CM-936 is the official Authorization for Release of Medical Records used by the U.S. Department of Labor’s Office of Workers' Compensation Programs. It allows the agency to obtain medical information needed to process workers‑compensation claims.

What Is the CM-936 Form?

This form grants permission for physicians, hospitals, or other health providers to share a claimant’s medical records with the Department of Labor. It is required for both active claimants and the estates of deceased miners.

How to Complete the CM-936 Online with Formize

Instead of downloading the PDF and editing it in a separate program, you can fill the form directly on our site using the Formize PDF Filler app. Follow the simple steps below:

  • Step 1: Click the "Fill out this form" button on this page.
  • Step 2: Wait a few seconds while the Formize PDF Filler loads the CM-936 document.
  • Step 3: Enter the requested information in each fillable field. The interface highlights required fields.
  • Step 4: Review your entries for accuracy.
  • Step 5: Click Submit to download a completed PDF or print it for mailing.

Common Mistakes to Avoid

Even a small error can delay your workers‑compensation claim. Keep these tips in mind:

  • Do not leave required fields blank – the form will not validate.
  • Use the exact legal name as it appears on the claimant’s identification.
  • Provide a current address and a reliable phone number for follow‑up.
  • Sign the form in the designated signature box; an electronic signature is accepted when using Formize.
  • Check the date format (MM/DD/YYYY) before submitting.

Where to Submit the Completed Form

After you have saved the completed CM-936 PDF, mail it to the Office of Workers' Compensation Programs at the address listed on the form, or upload it through the Department of Labor’s online portal if you have an account.

Need help? Review the FAQs below or contact your local workers’ compensation office for additional guidance.

FAQ
  • Who needs to fill out the CM-936 form?

    Any claimant or the estate of a deceased miner who needs the Department of Labor to obtain medical records for a workers‑compensation claim.

  • Can I sign the CM-936 electronically?

    Yes. The Formize PDF Filler accepts electronic signatures that are legally valid for this form.

  • What if I make a mistake after submitting?

    Download a fresh copy of the CM-936, correct the error, and resend the revised PDF to the Office of Workers' Compensation Programs.

  • Is there a filing fee for the CM-936?

    No. The authorization form is free of charge; however, there may be fees for obtaining medical records from providers.

  • How long does it take for the Department of Labor to process the form?

    Processing time varies, but once the completed CM-936 is received, the agency typically reviews it within 10‑15 business days.

  • Can I submit the CM-936 by email?

    The Department of Labor prefers a mailed hard copy, but some regional offices accept a scanned PDF via secure email. Check the address on the form for details.

  • Do I need a notary for the CM-936?

    No notarization is required; a valid signature (handwritten or electronic) is sufficient.

HOW TO

How to fill out CM-936 form for free, online in 5 easy steps:

  1. 1
    Click the Fill Out Button
    Press the "Fill out this form" button on the page to launch the Formize PDF Filler.
  2. 2
    Wait for the Form to Load
    The CM-936 document will appear in the browser within a few seconds.
  3. 3
    Enter Your Information
    Complete each highlighted field with accurate data. Required fields are marked with an asterisk.
  4. 4
    Review and Sign
    Double‑check all entries, then add your electronic signature in the signature box.
  5. 5
    Download or Print
    Click "Submit" to download the finished PDF or print it for mailing to the Department of Labor.
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ABOUT

Department of Labor (DOL) Forms

CM-936 form is one of the official forms that are used by the United States Department of Labor and its various agencies to collect information, administer programs, and enforce labor-related laws and regulations. The Department of Labor is a federal executive department responsible for promoting and protecting the welfare of workers, ensuring fair employment practices, and overseeing various aspects of labor and employment in the United States.

Here are some examples of Department of Labor forms:

Employment Eligibility Verification (Form I-9): While administered by the U.S. Citizenship and Immigration Services (USCIS), Form I-9 is often associated with the Department of Labor. It is used by employers to verify the identity and employment eligibility of individuals hired for employment in the United States.

Family and Medical Leave Act (FMLA) Forms: The DOL's Wage and Hour Division administers the FMLA, and various forms are used to implement and comply with the provisions of this federal law, including the Certification of Health Care Provider form and the FMLA Notice of Eligibility and Rights & Responsibilities form.

Occupational Safety and Health Administration (OSHA) Forms: OSHA, a division of the DOL, requires certain employers to maintain records of workplace injuries and illnesses using forms such as OSHA Form 300, OSHA Form 300A, and OSHA Form 301.

Unemployment Insurance Forms: The DOL's Employment and Training Administration oversees the Unemployment Insurance (UI) program, and various forms are used by state workforce agencies to administer and process UI benefits claims.

Wage and Hour Compliance Forms: The DOL's Wage and Hour Division enforces various labor laws, including the Fair Labor Standards Act (FLSA) and the Family and Medical Leave Act (FMLA). Employers may be required to use specific forms to maintain compliance with these laws, such as records of hours worked, wage rates, and other related information.

These examples represent some common categories of Department of Labor forms, but there are many other forms used by the DOL and its various agencies to carry out their responsibilities related to labor and employment. The specific forms required may vary depending on the program, regulation, or enforcement action involved. It's advisable to visit the official website of the U.S. Department of Labor (www.dol.gov) or consult with the relevant DOL agencies or legal professionals to obtain accurate and up-to-date information regarding the specific DOL forms relevant to your labor-related needs or compliance requirements.

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