DCMWC Part B Claimant Overpayment Submission Form

Description: This form is to be used to repay benefits overpaid by DCMWC as the result of death of the beneficiary or a change in the status of eligibility.
Form Number: DCMWC CLAIMANT OVERPAYMENT PART B

DCMWC Part C Claimant Overpayment Submission Form

Description: This form is to be used to repay benefits overpaid by DCMWC as the result of death of the beneficiary or a change in the status of eligibility.
Form Number: DCMWC CLAIMANT OVERPAYMENT PART C

DCMWC Responsible Operator Benefit Reimbursement Form

Description: This form is to be used to repay the Black Lung Trust Fund for benefits that were paid to the beneficiary prior to the final award being awarded.
Form Number: DCMWC RESPONSIBLE OPERATOR REIMBURSMENT

DEEOIC Pharmacy Overpayment Submission Form

Description: This form is to be used to return overpayments to DEEOIC. Please note that overpayment submissions should only be made if there is a related Transaction Control Number (TCN), as well as a specific request from DEEOIC to return the overpayment. Overpayment submissions without the TCN will be rejected.
Form Number: DEEOIC PHARM OVERPAYMENT

DEEOIC Provider Overpayment Submission Form

Description: This form is to be used to return overpayments to DEEOIC. Please note that overpayment submissions should only be made if there is a related Transaction Control Number (TCN), as well as a specific request from DEEOIC to return the overpayment. Overpayment submissions without the TCN will be rejected.
Form Number: DEEOIC OVERPAYMENT

DFEC Overpayment Submission Form

Description: To repay debts incurred as a result of overpayment of compensation.
Form Number: DFEC Washington DC

DLHWC Annual Assessment Form

Description: Use this form to pay your Annual Assessment
Form Number: DHLWC Annual Assessment Form

FECA Subrogation

Description: To repay debts incurred as a result of overpayment of compensation
Form Number: DFEC National Office

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