Forms By Title

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C

D

E

F

G

H

I

J

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M

N

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P

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U

V

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Y

Z

A

• Annual Return/Report of Employee Benefit Plan
• Application for Alien Employment Certification (Part A)
• Application for Alien Employment Certification (Part B)
• Application for Authority to Employ Workers with Disabilities at Special Minimum Wages
• Application for EFAST Electronic Signature and Codes for EFAST Transmitters and Signature Developers

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B

Titles currently unavailable in this category.


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C

• Certificate of Electrical/Noise Training
• Certificate of Training
• Certification for Serious Injury or Illness of Covered Servicemember -- for Military Family Leave
• Certification of Health Care Provider for Employee’s Serious Health Condition
• Certification of Health Care Provider for Family Member’s Serious Health Condition
• Certification of Physical Qualification for Mine Rescue Work
• Certification of Qualifying Exigency For Military Family Leave
• CM-1159, Report of Arterial Blood Gas Study
• CM-2907, Report of Ventilatory Study
• CM-2970, Operator Response to Schedule for Submission of Additional Evidence
• CM-2970a, Operator Response to Notice of Claim
• CM-623, Representative Payee Report
• CM-623S, Representative Payee Report
• CM-787, Physician's/Medical Officer's Statement
• CM-893, Certificate of Medical Necessity
• CM-908, Notice of Termination, Suspension, Reduction or Increase in Benefit Payments
• CM-910, Request To Be Selected As Payee
• CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act
• CM-911a, Employment History
• CM-912, Survivor's Form For Benefits Under The Black Lung Benefits Act
• CM-913, Description Of Coal Mine Work and Other Employment
• CM-921, Instructions For Completion of Form CM-921
• CM-929, Report of Changes That May Affect Your Black Lung Benefits
• CM-929p, Report of Changes That May Affect Your Black Lung Benefits
• CM-933, Roentgenographic Interpretation
• CM-933b, Roentgenographic Quality Rereading
• CM-936, Authorization For Release Of Medical Information (Black Lung Benefits)
• CM-972, Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The of Labor
• CM-981, Certification by School Official
• CM-988, Medical History and Examination for Coal Mine Workers' Pneumoconiosis
• Complaint of Discrimination in Employment Under Federal Government Contracts
• Contractor Identification (ID) Request

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D

• DFEC CA-1, Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
• DFEC CA-10, What A Federal Employee Should Do When Injured At Work
• DFEC CA-1031, Letter to Dependants to Verify Claimant Support
• DFEC CA-1074, Letter to Parents in Death Claim Development
• DFEC CA-1108, Statement of Recovery Letter with Long Form
• DFEC CA-1122, Statement of Recovery Letter with Short Form
• DFEC CA-12, Claim For Continuance of Compensation Under the Federal Employees' Compensation Act
• DFEC CA-17, Duty Status Report
• DFEC CA-2, Notice of Occupational Disease and Claim for Compensation
• DFEC CA-20, Attending Physician's Report
• DFEC CA-2231, Claim for Reimbursement Assisted Reemployment
• DFEC CA-278, Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
• DFEC CA-2a, Notice of Recurrence
• DFEC CA-35, Evidence Required in Support of a Claim for Occupational Disease
• DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children
• DFEC CA-5b, Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
• DFEC CA-6, Official Supervisor's Report of Employee's Death
• DFEC CA-7, Claim for Compensation
• DFEC CA-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease
• DFEC CA-722, Notice of Law Enforcement Officer's Death
• DFEC CA-7a, Time Analysis Form
• DFEC CA-7b, Leave Buy Back (LBB) Worksheet/Certification and Election
• DLHWC (Longshore) LS-1, Request for Examination and/or Treatment
• DLHWC (Longshore) LS-18, Pre-Hearing Statement
• DLHWC (Longshore) LS-200, Report of Earnings
• DLHWC (Longshore) LS-201, Notice of Employee's Injury or Death
• DLHWC (Longshore) LS-202, Employer's First Report of Injury or Occupational Illness
• DLHWC (Longshore) LS-203, Employee's Claim for Compensation
• DLHWC (Longshore) LS-204, Attending Physician's Supplementary Report
• DLHWC (Longshore) LS-205, Physician's Report on Impairment of Vision
• DLHWC (Longshore) LS-206, Payment of Compensation Without Award
• DLHWC (Longshore) LS-207, Notice of Controversion of Right to Compensation
• DLHWC (Longshore) LS-208, Notice of Final Payment or Suspension of Compensation Payments
• DLHWC (Longshore) LS-210, Employer's Supplementary Report of Accident or Occupational Illness
• DLHWC (Longshore) LS-262, Claim for Death Benefits
• DLHWC (Longshore) LS-265, Certification of Funeral Expenses
• DLHWC (Longshore) LS-266, Application for Continuation of Death Benefit for Student
• DLHWC (Longshore) LS-267, Claimant's Statement
• DLHWC (Longshore) LS-271, Application for Self-Insurance
• DLHWC (Longshore) LS-274, Report of Injury Experience of Insurance Carrier or of Self-Insured Employer
• DLHWC (Longshore) LS-275ic, Agreement and Undertaking(Insurance Carrier)
• DLHWC (Longshore) LS-275si, Agreement and Undertaking (Self-Insured Employer)
• DLHWC (Longshore) LS-276, Application for Security Deposit Determination
• DLHWC (Longshore) LS-33, Approval of Compromise of Third Person Cause of Action
• DLHWC (Longshore) LS-426, Request for Earnings Information

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E

• EEOICP EE-1, Claim for Benefits under Energy Employees Occupational Illness Compensation Program Act
• EEOICP EE-2, Claim for Survivor Benefits under Energy Employees Occupational Illness Compensation Program Act
• EEOICP EE-3, Employment History for Claim Under Energy Employees Occupational Illness Compensation Program Act
• EEOICP EE-4, Employment History Affidavit for Claim Under Energy Employees Occupational Illness Compensation Program Act
• EEOICP EE-7, Medical Requirements under the Energy Employees Occupational Illness Compensation Program Act
• Electrically Operated Mining Equipment Field Approval Application (Coal Operator)
• Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference

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F

• Family and Medical Leave Act of 1993 (Employer Response to Employee Request for Family or Medical Leave)
• Federal Contractor Veterans' Employment Report
• FMLA Designation Notice
• Form LM-1 Labor Organization Information Report
• Form LM-10 Employer Report
• Form LM-15 Trusteeship Report
• Form LM-15A Report on Selection of Delegates and Officers
• Form LM-16 Terminal Trusteehip Report
• Form LM-2 Labor Organization Annual Report
• Form LM-20 Agreement and Activities Report (Consultant)
• Form LM-21 Receipts and Disbursements Report (Consultant)
• Form LM-3 Labor Organization Annual Report
• Form LM-30 Labor Organization Officer and Employee Report
• Form LM-4 Labor Organization Annual Report
• Form S-1 Surety Company Annual Report

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G

Titles currently unavailable in this category.


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H

• H-1B Nonimmigrant Information Form
• H-1B Specialty (Professional) Workers
• H-1C Nurses for Disadvantaged Areas
• Health Activity Certification or Hoisting Engineers Qualification Request Form

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I

Titles currently unavailable in this category.


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J

Titles currently unavailable in this category.


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K

Titles currently unavailable in this category.


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L

• Labor Condition Application and Requirements for Employer Using Nonimmigrants on H-1B Visas
• Legal Identification (ID) Report

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M

• Medical Travel Refund Request
• Mine Accident, Injury and Illness Report
• Mine Identification (ID) Request
• Miner Medical Reimbursement Form
• MSHA Notification of Representative of Miners

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N

• Notice of Alleged Safety or Health Hazards

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O

• Optional Use Payroll Form Under the Davis-Bacon Act
• OWCP-1, Agreement and Undertaking DLHWC (Longshore) & DCMWC (Black Lung)
• OWCP-1168, Black Lung Provider Enrollment Form
• OWCP-1500, Health Insurance Claim Form
• OWCP-16, Rehabilitation Plan And Award
• OWCP-17, Rehabilitation Maintenance Certificate
• OWCP-20, Overpayment Recovery Questionnaire
• OWCP-44, Rehabilitation Action Report
• OWCP-5a, Work Capacity Evaluation For Psychiatric/Psychological Conditions
• OWCP-5b, Work Capacity Evaluation For Cardiovascular/Pulmonary Conditions
• OWCP-5c, Work Capacity Evaluation for Musculoskeletal Conditions
• OWCP-915, Claim for Medical Reimbursement
• OWCP-957, Medical Travel Refund Request

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P

Titles currently unavailable in this category.


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Q

• Quarterly Mine Employment and Coal Production Report

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R

• Record of Individual Exposure to Radon Daughters
• Report of Payments

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S

• Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages

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T

• Trust Annual Report

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U

• Uniform Billing Form

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V

Titles currently unavailable in this category.


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W

• Wage Statement
• Wage Statement (In Spanish)
• Worker Information, Terms and Conditions of Employment
• Worker Information, Terms and Conditions of Employment (In Spanish)

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X

Titles currently unavailable in this category.


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Y

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Z

Titles currently unavailable in this category.


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