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May 8, 2009   
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The Employee Benefits Security Administration makes every effort to ensure compliance with applicable Federal law, including, but not limited to, the Privacy Act of 1974, the Paperwork Reduction Act of 1995, and the Freedom of Information Act. Although electronic mail is used by millions to communicate each day, it is not always secure. If you have a concern about security, please contact the Employee Benefits Security Administration by mail or telephone. We may share the information you provide with others. Read the Privacy and Security Statement to learn more about how we may use the information you send to us.

Please provide the following information: (*required field)

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Your Inquiry

This form is an approved information collection request under Office of Management and Budget clearance number 1225-0059 (exp 09/30/09).  Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number.  Use of this form is entirely voluntary.

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