DCMWC Forms

OWCP’s Division of Coal Mine Workers' Compensation has made a variety of forms available online. These forms are only available in PDF format. In order to view and/or print PDF documents you must have a PDF viewer. It is highly recommended that you have the most current version (click on Adobe Acrobat Reader to download the current version) available on your workstation.

The forms in the list below may be completed manually via the print form option or electronically via the electronic fill/submit option:

Print Form Option

Most of DCMWC’s forms are available online to print and to manually fill and submit. Simply click on the appropriate form and print it using the [Print] button provided near the top of the form. Write or type the required information on the hardcopy and authorize the form, if applicable, with a hand-written signature. Then mail the completed form to our central mailroom at the following address:

U.S. Department of Labor OWCP/DCMWC
P.O. Box 8307
London, KY 40742-8307

IMPORTANT: We are working to have our forms and business reply envelopes updated with the London, KY addresses. Until that is complete, the mailroom currently listed in San Antonio, TX will be forwarding all mail to London, KY. To reduce mail processing delays, please use the London, KY address for mailing, even if the address on the form is San Antonio, TX.

Form-Fill Option

Forms noted with an asterisk (*) may be electronically filled. Simply click on the appropriate form, fill out the form using your computer keyboard and the <TAB> key or your mouse to navigate between form fields. Print the form (use the Print button on or near the top of the form), authorize the form (if applicable provide hand-written signature) and mail the completed form to the DCMWC office you normally send to for this process.

NOTE: When printing these files please remember to use the Adobe Acrobat Reader print icon or the [Print] button on the form, itself, and NOT your browser's print icon on the browser toolbar.