Employee Benefits Security Administration

U.S.

Official Website: https://www.dol.gov/agencies/ebsa

The Employee Benefits Security Administration (EBSA) offers information and assistance on employer-sponsored retirement benefit and health benefit plans.

Forms & Documents

Browse all Employee Benefits Security Administration government forms

21 - 40 of 158 forms

Form Title Topics
Application for Alien Employment Certification - Part A
Application for Alien Employment Certification - Part B
Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor
Application for Certificateto Employ Homeworkers
Application for Continuation of Death Benefit for Student
Application for Permanent Employment Certification
Application for Security Deposit Determination. State Guarantee Fund Longshore Security Factor Chart
Application for Self-Insurance instructions
Application for Special Industrial Homeworker Certificate
Application For Special Relief Fund
Application for Temporary Employment Certification
Application to Employ Student-Learners at Subminimum Wages
Application to write Longshore Insurance (Carriers)
Approval of Compromise of Third Person Cause of Action
Attending Physician's Report
Attending Physician's Supplementary Report
Attorney Fee Approval Request
Authorization For Release Of Medical Information (Black Lung Benefits)
Black Lung Benefits Act Evidence Summary Form
Carrier's Report of Issuance of Policy (formerly Card Report of Insurance)

Contact Information & Office Locations

61 - 64 of 64 contact points

Washington DC - Matthew Gisler - Acting

Address:
1335 East-West Hwy
Suite 200
Silver Spring, MD 20910

Phone numbers:
  • (202) 693-8700
Fax numbers:
  • (202) 693-8736

West Virginia

Address:
Washington District Office
1335 East-West Hwy
Ste 200
Silver Spring, MD 20910

Phone numbers:
  • (202) 693-8700
Fax numbers:
  • (202) 693-8736

Wisconsin

Address:
Chicago Regional Office
John C. Kluczynski Federal Bldg
230 S. Dearborn Street
Ste 2160
Chicago, IL 60604

Phone numbers:
  • (312) 353-0900
Fax numbers:
  • (312) 353-1023

Wyoming

Address:
Kansas City Regional Office
2300 Main St,
Ste 1100
Kansas City, MO 64108

Phone numbers:
  • (816) 285-1800
Fax numbers:
  • (816) 285-1888

Have Questions About This Agency?
Ask An Expert For Help:

Questions and comments are moderated. Minimum of 10 characters.

All questions and comments are moderated and publicly viewable. Please do not post private or sensitive information such as names, addresses, phone numbers, emails, confidential financial and legal details.

Login or sign up to submit questions