Division of Coal Mine Workers' Compensation (DCMWC)
To facilitate the Form SSA-581 submission process, DCMWC will send current versions of the form to claimants and their representatives following the receipt of a claim. Effective September 20, 2024, this includes one form for the miner's entire wage history, starting at age 16.
Claimants and their representatives can then review the information on the form, and, if appropriate, sign, date and return them to DCMWC.
If for some reason the information is not correct, the representative should submit a correct SSA-581 and also advise DCMWC of the error.
Claimants or their representatives should not preemptively submit signed Forms SSA-581 that are otherwise blank or incomplete. In no case will DCMWC accept blank SSA-581s with only a claimant's signature. Any forms submitted with only a signature will be returned or destroyed only after discussion with the representative or claimant.
Properly reviewed and completed Forms SSA-581 must be mailed to DCMWC at:
U.S. Department of Labor OWCP/DCMWC
P.O. Box 8307
London, KY 40742-8307
COMPLETED FORMS MUST NOT BE SUBMITTED DIRECTLY TO THE SOCIAL SECURITY ADMINISTRATION