[Code of Federal Regulations]
[Title 20, Volume 2]
[Revised as of April 1, 2004]
From the U.S. Government Printing Office via GPO Access
[CITE: 20CFR410.221]

[Page 610]
 
                      TITLE 20--EMPLOYEES' BENEFITS
 
               CHAPTER III--SOCIAL SECURITY ADMINISTRATION
 
PART 410_FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV_BLACK 
LUNG BENEFITS (1969	 )--Table of Contents
 
Subpart B_Requirements for Entitlement; Duration of Entitlement; Filing 
                         of Claims and Evidence
 
Sec. 410.221  Prescribed application and request forms.

    (a) Claims shall be made as provided in this subpart on such 
application forms and in accordance with such instructions (provided 
thereon or attached thereto) as are prescribed by the Administration.
    (b) The application forms used by the public to file claims for 
benefits under part B of title IV of the Act are SSA-46 (application for 
benefits under the Federal Coal Mine Health and Safety Act of 1969 (coal 
miner's claim of total disability)), SSA-47 (application for benefits 
under the Federal Coal Mine Health and Safety Act of 1969 (widow's 
claim)), SSA-48 (application for benefits under the Black Lung Benefits 
Act of 1972 (child's claim)), and SSA-49 (application for benefits under 
the Black Lung Act of 1972 (parent's, brother's, or sister's claim)).
    (c) The form used by an individual to request that such individual 
be selected as a representative payee or by a dependent to request that 
payment be certified to him separately is SSA-50 (Request to be Selected 
as Payee).
    (d) For further information about some of the forms used in the 
administration of part B of title IV of the Act, see Sec. Sec. 
422.505(b), 422.515, 422.525, and 422.527 of this chapter.

[37 FR 20637, Sept. 30, 1972]