TN 1 (06-86)

Form SSA-101-U3 (Determination of Award) will be used to authorize payment of all black lung allowances and will be prepared manually in the Office of Disability Operations. The chief differences between the SSA-101-U3 when used to authorize black lung benefit payments and the SSA-101-U3 when used to authorize disability benefit payments are: (1) the benefit computation data in item 4 of the form will be omitted; (2) the benefit symbol(s) shown in items 6 and 12 will be “LM” for miner, “LW” for widow, etc. and (3) the annotation “BLACK LUNG CASE” will appear in item 11 (Remarks). The following BIC chart reflects the benefit symbols for black lung claimants and auxiliaries.