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

41 - 60 of 158 forms

Form Title Topics
Certificate of Medical Necessity
Certificate of Training Form
Certification of Funeral Expenses
Claimant's Statement
Claim for Compensation
Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren
Claim for Compensation by Widow, Widower, and/or Children
Claim For Continuance of Compensation Under the Federal Employees' Compensation Act
Claim for Death Benefits
Claim For Medical Reimbursement
Claim for Reimbursement Assisted Reemployment
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity
Complaint/Apparent Violation Form
DBRA Certified Payroll Form
Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a
DFE/Participating Plan Information
DFE/Participating Plan Information-2016
DFE/Participating Plan Information-2017
DFE/Participating Plan Information-2018

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

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