Content Last Revised: 12/23/93 ---DISCLAIMER---

CFR	Code of Federal Regulations Pertaining to U.S. Department of Labor

Title 20

Employees' Benefits

Chapter VI

Employment Standards Administration, Department of Labor

Part 702

Administration and Procedure

Subpart B

Claims Procedures

• Section Number: 702.214
• Section Name: Notice; form and content.

    Notice shall be in writing on a form prescribed by the Director for 
this purpose; such form shall be made available to the employee or 
beneficiary by the employer. The notice shall be signed by the person 
authorized to give notice, and shall contain the name, address and 
Social Security Number (SSN) of the employee and, in death cases, also 
the SSN of the person seeking survivor benefits, and a statement of the 
time, place, nature and cause of the injury or death.
[58 FR 68032, Dec. 23, 1993]