Ventilatory study form documenting spirometry results, flow‑volume loops, miner cooperation, and bronchodilator response to assess Black Lung benefit eligibility.

This report is authorized by the Black Lung Benefits Act 30 U.S.C. 901 et seq. and the regulations of the U.S. Department of Labor governing the administration of such Act (20 CFR 725.412). Please check appropriate boxes below. While you are not required to respond, if you fail to do so within 30 days after the District Director's issuance of the Schedule for the Submission of Additional Evidence naming you as a responsible operator, you shall be deemed to have accepted liability for this claim (that is, that you will be responsible for payment of benefits to which the claimant is finally determined to be entitled) and to have waived your right to contest your liability in any further proceeding conducted with respect to this claim. You also will be deemed to have contested the claimant’s entitlement to benefits.