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

121 - 140 of 158 forms

Form Title Topics
Notice of Law Enforcement Officer's Death
Notice of Law Enforcement Officer's Injury Or Occupational Disease
Notice of Occupational Disease and Claim for Compensation
Notice of Termination, Suspension, Reduction or Increase in Benefit Payments
Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity
Official Supervisor's Report of Employee's Death
Operator Response to Notice of Claim
Operator Response to Schedule for Submission of Additional Evidence
Payment of Compensation Without Award
Physician's/Medical Officer's Statement
Pre-Hearing Statement
Provider Enrollment form
Rehabilitation Action Report
Report of Changes That May Affect Your Black Lung Benefits
Report of Earnings
Request for Appointment of Mediator
Request for Examination and/or Treatment
Request for Intervention
Retirement Plan Information
Retirement Plan Information-2016

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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