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

101 - 120 of 158 forms

Form Title Topics
Insurance Information-2016
Insurance Information-2017
Insurance Information-2018
Insurance Information-2019
Insurance Information-2020
Leave Buy Back (LBB) Worksheet/Certification and Election
Letter to Dependants to Verify Claimant Support
Letter to Parents in Death Claim Development
LHWCA Prehearing Statement Form
LHWCA Uniform Stipulations Form
Medical History and Examination for Coal Mine Workers' Pneumoconiosis
Medical Travel Refund Request
Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information
Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information
Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information
Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information-2017
Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information-2018
Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information-2020
Notice of Employee's Injury or Death
Notice of Final Payment or Suspension of Compensation Payments

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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