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A
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Annual Return/Report of Employee Benefit Plan
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Application for Alien Employment Certification (Part A)
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Application for Alien Employment Certification (Part B)
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Application for Authority to Employ Workers with Disabilities at Special Minimum Wages
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Application for EFAST Electronic Signature and Codes for EFAST Transmitters and Signature Developers
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BTitles currently unavailable in this category.
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C
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Certificate of Electrical/Noise Training
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Certificate of Training
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Certification of Physical Qualification for Mine Rescue Work
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CM-1159, Report of Arterial Blood Gas Study
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CM-2907, Report of Ventilatory Study
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CM-2970, Operator Response to Schedule for Submission of Additional Evidence
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CM-2970a, Operator Response to Notice of Claim
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CM-623, Representative Payee Report
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CM-623S, Representative Payee Report
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CM-787, Physician's/Medical Officer's Statement
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CM-893, Certificate of Medical Necessity
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CM-908, Notice of Termination, Suspension, Reduction or Increase in Benefit Payments
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CM-910, Request To Be Selected As Payee
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CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act
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CM-911a, Employment History
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CM-912, Survivor's Form For Benefits Under The Black Lung Benefits Act
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CM-913, Description Of Coal Mine Work and Other Employment
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CM-921, Instructions For Completion of Form CM-921
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CM-929, Report of Changes That May Affect Your Black Lung Benefits
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CM-929p, Report of Changes That May Affect Your Black Lung Benefits
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CM-933, Roentgenographic Interpretation
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CM-933b, Roentgenographic Quality Rereading
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CM-936, Authorization For Release Of Medical Information (Black Lung Benefits)
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CM-972, Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The of Labor
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CM-981, Certification by School Official
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CM-988, Medical History and Examination for Coal Mine Workers' Pneumoconiosis
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Complaint of Discrimination in Employment Under Federal Government Contracts
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Contractor Identification (ID) Request
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D
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DFEC CA-1, Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
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DFEC CA-10, What A Federal Employee Should Do When Injured At Work
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DFEC CA-1031, Letter to Dependants to Verify Claimant Support
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DFEC CA-1074, Letter to Parents in Death Claim Development
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DFEC CA-1108, Statement of Recovery Letter with Long Form
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DFEC CA-1122, Statement of Recovery Letter with Short Form
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DFEC CA-12, Claim For Continuance of Compensation Under the Federal Employees' Compensation Act
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DFEC CA-17, Duty Status Report
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DFEC CA-2, Notice of Occupational Disease and Claim for Compensation
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DFEC CA-20, Attending Physician's Report
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DFEC CA-2231, Claim for Reimbursement Assisted Reemployment
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DFEC CA-278, Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
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DFEC CA-2a, Notice of Recurrence
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DFEC CA-35, Evidence Required in Support of a Claim for Occupational Disease
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DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children
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DFEC CA-5b, Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
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DFEC CA-6, Official Supervisor's Report of Employee's Death
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DFEC CA-7, Claim for Compensation
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DFEC CA-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease
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DFEC CA-722, Notice of Law Enforcement Officer's Death
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DFEC CA-7a, Time Analysis Form
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DFEC CA-7b, Leave Buy Back (LBB) Worksheet/Certification and Election
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DLHWC (Longshore) LS-1, Request for Examination and/or Treatment
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DLHWC (Longshore) LS-18, Pre-Hearing Statement
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DLHWC (Longshore) LS-200, Report of Earnings
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DLHWC (Longshore) LS-201, Notice of Employee's Injury or Death
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DLHWC (Longshore) LS-202, Employer's First Report of Injury or Occupational Illness
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DLHWC (Longshore) LS-203, Employee's Claim for Compensation
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DLHWC (Longshore) LS-204, Attending Physician's Supplementary Report
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DLHWC (Longshore) LS-205, Physician's Report on Impairment of Vision
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DLHWC (Longshore) LS-206, Payment of Compensation Without Award
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DLHWC (Longshore) LS-207, Notice of Controversion of Right to Compensation
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DLHWC (Longshore) LS-208, Notice of Final Payment or Suspension of Compensation Payments
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DLHWC (Longshore) LS-210, Employer's Supplementary Report of Accident or Occupational Illness
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DLHWC (Longshore) LS-262, Claim for Death Benefits
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DLHWC (Longshore) LS-265, Certification of Funeral Expenses
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DLHWC (Longshore) LS-266, Application for Continuation of Death Benefit for Student
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DLHWC (Longshore) LS-267, Claimant's Statement
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DLHWC (Longshore) LS-271, Application for Self-Insurance
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DLHWC (Longshore) LS-274, Report of Injury Experience of Insurance Carrier or of Self-Insured Employer
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DLHWC (Longshore) LS-275ic, Agreement and Undertaking(Insurance Carrier)
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DLHWC (Longshore) LS-275si, Agreement and Undertaking (Self-Insured Employer)
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DLHWC (Longshore) LS-276, Application for Security Deposit Determination
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DLHWC (Longshore) LS-33, Approval of Compromise of Third Person Cause of Action
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DLHWC (Longshore) LS-426, Request for Earnings Information
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E
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EEOICP EE-1, Claim for Benefits under Energy Employees Occupational Illness Compensation Program Act
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EEOICP EE-2, Claim for Survivor Benefits under Energy Employees Occupational Illness Compensation Program Act
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EEOICP EE-3, Employment History for Claim Under Energy Employees Occupational Illness Compensation Program Act
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EEOICP EE-4, Employment History Affidavit for Claim Under Energy Employees Occupational Illness Compensation Program Act
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EEOICP EE-7, Medical Requirements under the Energy Employees Occupational Illness Compensation Program Act
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Electrically Operated Mining Equipment Field Approval Application (Coal Operator)
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Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference
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F
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Family and Medical Leave Act of 1993 (Certification of Health Care Provider)
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Family and Medical Leave Act of 1993 (Employer Response to Employee Request for Family or Medical Leave)
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Federal Contractor Veterans' Employment Report
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Form LM-1 Labor Organization Information Report
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Form LM-10 Employer Report
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Form LM-15 Trusteeship Report
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Form LM-15A Report on Selection of Delegates and Officers
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Form LM-16 Terminal Trusteehip Report
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Form LM-2 Labor Organization Annual Report
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Form LM-20 Agreement and Activities Report (Consultant)
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Form LM-21 Receipts and Disbursements Report (Consultant)
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Form LM-3 Labor Organization Annual Report
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Form LM-30 Labor Organization Officer and Employee Report
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Form LM-4 Labor Organization Annual Report
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Form S-1 Surety Company Annual Report
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GTitles currently unavailable in this category.
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H
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H-1B Nonimmigrant Information Form
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H-1B Specialty (Professional) Workers
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H-1C Nurses for Disadvantaged Areas
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Health Activity Certification or Hoisting Engineers Qualification Request Form
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ITitles currently unavailable in this category.
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JTitles currently unavailable in this category.
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KTitles currently unavailable in this category.
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L
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Labor Condition Application and Requirements for Employer Using Nonimmigrants on H-1B Visas
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Legal Identification (ID) Report
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M
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Medical Travel Refund Request
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Mine Accident, Injury and Illness Report
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Mine Identification (ID) Request
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Miner Medical Reimbursement Form
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MSHA Notification of Representative of Miners
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N
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Notice of Alleged Safety or Health Hazards
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O
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Optional Use Payroll Form Under the Davis-Bacon Act
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OWCP-1, Agreement and Undertaking
DLHWC (Longshore) & DCMWC (Black Lung)
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OWCP-1168, Black Lung Provider Enrollment Form
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OWCP-1500, Health Insurance Claim Form
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OWCP-16, Rehabilitation Plan And Award
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OWCP-17, Rehabilitation Maintenance Certificate
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OWCP-20, Overpayment Recovery Questionnaire
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OWCP-44, Rehabilitation Action Report
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OWCP-5a, Work Capacity Evaluation For Psychiatric/Psychological Conditions
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OWCP-5b, Work Capacity Evaluation For Cardiovascular/Pulmonary Conditions
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OWCP-5c, Work Capacity Evaluation for Musculoskeletal Conditions
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OWCP-915, Claim for Medical Reimbursement
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OWCP-957, Medical Travel Refund Request
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PTitles currently unavailable in this category.
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Q
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Quarterly Mine Employment and Coal Production Report
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R
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Record of Individual Exposure to Radon Daughters
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Report of Payments
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S
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Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages
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T
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Trust Annual Report
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U
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Uniform Billing Form
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VTitles currently unavailable in this category.
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W
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Wage Statement
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Wage Statement (In Spanish)
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Worker Information, Terms and Conditions of Employment
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Worker Information, Terms and Conditions of Employment (In Spanish)
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XTitles currently unavailable in this category.
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YTitles currently unavailable in this category.
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ZTitles currently unavailable in this category.
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