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

1 - 20 of 64 contact points

Alabama

Address:
Atlanta Regional Office
61 Forsyth St, SW
Ste 7B54
Atlanta, GA 30303

Phone numbers:
  • (404) 302-3900
Fax numbers:
  • (404) 302-3975

Alaska

Address:
Seattle District Office
300 Fifth Avenue
Ste 1110
Seattle, WA 98104

Phone numbers:
  • (206) 757-6781
Fax numbers:
  • (206) 757-6662

American Samoa

Address:
Los Angeles Regional Office
35 N. Lake Ave.
Ste 300
Pasadena, CA 91101

Phone numbers:
  • (626) 229-1000
Fax numbers:
  • (626) 229-1098

Arizona

Address:
Los Angeles Regional Office
35 N. Lake Ave.,
Ste 300
Pasadena, CA 91101

Phone numbers:
  • (626) 229-1000
Fax numbers:
  • (626) 229-1098

Arkansas

Address:
Dallas Regional Office
525 South Griffin St,
Rm 900
Dallas, TX 75202-5025

Phone numbers:
  • (972) 850-4500
Fax numbers:
  • (214) 767-1055

California (northern)

Address:
San Francisco Regional Office
90 7th St
Ste 11-300
San Francisco, CA 94103

Phone numbers:
  • (415) 625-2481
Fax numbers:
  • (415) 625-2450

California (southern)

Address:
Los Angeles Regional Office
35 N. Lake Ave.
Ste 300
Pasadena, CA 91101

Phone numbers:
  • (626) 229-1000
Fax numbers:
  • (626) 229-1098

Colorado

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

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

Connecticut

Address:
Boston Regional Office
JFK Federal Bldg
15 New Sudbury St.
Rm 575
Boston, MA 02203

Phone numbers:
  • (617) 565-9600
Fax numbers:
  • (617) 565-9666

Delaware

Address:
Philadelphia Regional Office
1835 Market Street
21st Floor
Mailstop EBSA/21
Philadelphia, PA 19103-2968

Phone numbers:
  • (215) 861-5300
Fax numbers:
  • (215) 861-5347

Florida (northern)

Address:
Atlanta Regional Office
61 Forsyth St, SW
Ste 7B54
Atlanta, GA 30303

Phone numbers:
  • (404) 302-3900
Fax numbers:
  • (404) 302-3975

Florida (southern)

Address:
Miami District Office
1000 S Pine Island Road
Ste 100
Plantation, FL 33324

Phone numbers:
  • (954) 424-4022
Fax numbers:
  • (954) 424-0548

Georgia

Address:
Atlanta Regional Office
61 Forsyth St, SW
Ste 7B54
Atlanta, GA 30303

Phone numbers:
  • (404) 302-3900
Fax numbers:
  • (404) 302-3975

Guam

Address:
Los Angeles Regional Office
35 N. Lake Ave.
Ste 300
Pasadena, CA 91101

Phone numbers:
  • (626) 229-1000
Fax numbers:
  • (626) 229-1098

Hawaii

Address:
Los Angeles Regional Office
35 N. Lake Ave.
Ste 300
Pasadena, CA 91101

Phone numbers:
  • (626) 229-1000
Fax numbers:
  • (626) 229-1098

Idaho

Address:
Seattle District Office
300 Fifth Avenue
Ste 1110
Seattle, WA 98104

Phone numbers:
  • (206) 757-6781
Fax numbers:
  • (206) 757-6662

Illinois (northern)

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

Illinois (southern)

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

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

Indiana (northern)

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

Indiana (southern)

Address:
Cincinnati Regional Office
1885 Dixie Hwy
Ste 210
Ft. Wright, KY 41011-2664

Phone numbers:
  • (859) 578-4680
Fax numbers:
  • (859) 578-4688

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