Forms | U.S. Department of Labor

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field--name-field-bundles field--type-entity-reference-revisions field--label-hidden clearfix"> <div> <div class="paragraph dol-alerts paragraph--type--contextual-alerts paragraph--view-mode--default dol-alert-status-warning"> <div class="alert-status-container"> <i class="fa fa-exclamation-triangle" aria-hidden="true"></i> </div> <div class="alert-content-container"> <div class="field field--name-field-alert-headline field--type-string field--label-hidden clearfix"><p>Downloading Forms Notification</p></div> <div class="field field--name-field-alert-body field--type-text-long field--label-hidden clearfix"><p>In order to access a form you <strong>MUST:</strong></p> <ol> <li>Right-click or use Shift + F10 keys/context menu key (Windows) and then choose the "Save link as"</li> <li>Save the file on your computer</li> <li>Open the file saved on your computer</li> <li>Edit the file</li> </ol> </div> <div class="field field--name-field-alert-status field--type-list-string field--label-hidden clearfix">Warning</div> </div> <div class="alert-close-container"> <i class="fa fa-times" aria-hidden="true"></i> </div> </div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--row paragraph--view-mode--default row" style="background-color:;"> <div class="field field--name-field-bundles field--type-entity-reference-revisions field--label-hidden clearfix"> <div> <div class="paragraph paragraph--type--text-block paragraph--view-mode--default"> <div class="field field--name-field-p-text field--type-text-long field--label-hidden clearfix"><p>These are the most frequently requested U.S. Department of Labor forms. You can complete some forms online, while you can download and print all others.</p></div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion1"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a1"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Forms by Title</div> </button> </span> <div id="a1" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/reporting-and-filing/form-5500">5500 Series</a> (Form Number - 5500; Agency - Employee Benefits Security Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_APPEAR_AND_TESTIFY_DEPOSITION_04_2020_EMAIL_PROCESSING.PDF">Administrative Subpoena to Appear & Testify at a Deposition</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_APPEAR_AND_TESTIFY_HEARING_04_2020_EMAIL_PROCESSING.PDF">Administrative Subpoena to Appear & Testify at a Hearing</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_PRODUCE_DOCUMENTS_PERMIT_INSPECTION_OALJ_04_2020_EMAIL_PROCESSING.PDF">Administrative Subpoena to Produce Documents, Information or Objects, or to Permit Inspection of Premises</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM20">Agreement and Activities Report</a> (Form Number - LM-20; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1.pdf">Agreement and Undertaking (Self-Insured Employer)</a> (Form Number - OWCP-01; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-275ic.pdf">Agreement and Undertaking (Insurance Carrier)</a> (Form Number - LS-275ic; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-275si.pdf">Agreement and Undertaking (Self-Insured Employer)</a> (Form Number - LS-275si; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_AGREEMENT_TO_MEDIATE_FORM_REVISED_04_11_2018.PDF">Agreement to Mediate</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/mas/pdfs/790.pdf">Agricultural and Food Processing Clearance Order</a> (Form Number - 790; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ecab/ab-1.pdf">Appeal Form</a> (Form Number - AB-1; Agency - Employees' Compensation Appeals Board)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-Form_750-PartA_508_Compliant.pdf">Application for Alien Employment Certification - Part A</a> (Form Number - 750A; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-Form_750-PartB_508_Compliant.pdf">Application for Alien Employment Certification - Part B</a> (Form Number - 750B; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-972.pdf">Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor</a> (Form Number - CM-972; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-200.pdf">Application for Authority to Employ Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture Under Regulations 29 C.F.R. Part 519</a> (Form Number - WH-200; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-202.pdf">Application for Authority to Employ Six or Fewer Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture Under Regulations 29 C.F.R. Part 519</a> (Form Number - WH-202; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226.pdf">Application for Authority to Employ Workers with Disabilities at Subminimum Wages</a> (Form Number - WH-226 ; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-46.pdf">Application for Certificateto Employ Homeworkers</a> (Form Number - WH-46; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-266.pdf">Application for Continuation of Death Benefit for Student</a> (Form Number - LS-266; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9089form.pdf">Application for Permanent Employment Certification</a> (Form Number - 9089; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9141.pdf">Application for Prevailing Wage Determination</a> (Form Number - 9141; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9141C.pdf">Application for Prevailing Wage Determination</a> (Form Number - 9141C; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-276.pdf">Application for Security Deposit Determination. State Guarantee Fund Longshore Security Factor Chart</a> (Form Number - LS-276; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-271.pdf">Application for Self-Insurance instructions</a> (Form Number - LS-271; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-2.pdf">Application for Special Industrial Homeworker Certificate</a> (Form Number - WH-2; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5.pdf">Application For Special Relief Fund</a> (Form Number - LS-5; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-205.pdf">Application to Employ Student-Learners at Subminimum Wages</a> (Form Number - WH-205; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-272.pdf">Application to write Longshore Insurance (Carriers)</a> (Form Number - LS-272; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-33.pdf">Approval of Compromise of Third Person Cause of Action</a> (Form Number - LS-33; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-20.pdf">Attending Physician's Report</a> (Form Number - CA-20; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/regs/compliance/ca-20_ES.pdf">Informe del médico tratante (Número de formulario - CA-20; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-204.pdf">Attending Physician's Supplementary Report</a> (Form Number - LS-204; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4.pdf">Attorney Fee Approval Request</a> (Form Number - LS-4; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-936.pdf">Authorization For Release Of Medical Information (Black Lung Benefits)</a> (Form Number - CM-936; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/BLACK_LUNG/REFERENCES/FORMS/USDOL_OALJ_BLBA_EVIDENCE_SUMMARY_FORM_01_2003.PDF">Black Lung Benefits Act Evidence Summary Form</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-570.pdf">Carrier's Report of Issuance of Policy (formerly Card Report of Insurance)</a> (Form Number - LS-570; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training">Certificate of Electrical/Noise Training</a> (Form Number - 5000-1; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-893.pdf">Certificate of Medical Necessity</a> (Form Number - CM-893; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-physical-qualification-mine-rescue-work">Certificate of Physical Qualification for Mine Rescue Work</a> (Form Number - 5000-3; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/certificate-training">Certificate of Training</a> (Form Number - 5000-23; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-5.pdf">Certificate of Training Form</a> (Form Number - WH-5; Agency - Wage and Hour Division)</li><li><a href="https://www.msha.gov/certificates-achievement-safety">Certificates of Achievement in Safety</a> (Form Number - N/A; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-981.pdf">Certification by School Official</a> (Form Number - CM-981; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-265.pdf">Certification of Funeral Expenses</a> (Form Number - LS-265; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7.pdf">Claim for Compensation</a> (Form Number - CA-7; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-5b.pdf">Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren</a> (Form Number - CA-5b; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-5.pdf">Claim for Compensation by Widow, Widower, and/or Children</a> (Form Number - CA-5; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-12.pdf">Claim For Continuance of Compensation Under the Federal Employees' Compensation Act</a> (Form Number - CA-12; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-262.pdf">Claim for Death Benefits</a> (Form Number - LS-262; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-915.pdf">Claim For Medical Reimbursement</a> (Form Number - OWCP-915; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2231.pdf">Claim for Reimbursement Assisted Reemployment</a> (Form Number - CA-2231; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-278.pdf">Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act</a> (Form Number - CA-278; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-41.pdf">Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity</a> (Form Number - CA-41; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-267.pdf">Claimant's Statement</a> (Form Number - LS-267; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6.pdf">Commutation Application</a> (Form Number - LS-6; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/mas/pdfs/Complaint_Apparent_Violation_Form_8429.pdf">Complaint/Apparent Violation Form</a> (Form Number - 8429; Agency - Employment and Training Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/contractor-id-request">Contractor ID Request</a> (Form Number - 7000-52; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9142C.pdf">CW-1 Application for Temporary Employment Certification</a> (Form Number - 9142C; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh347.pdf">DBRA Certified Payroll Form</a> (Form Number - WH-347; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/agencies/whd/government-contracts/construction/surveys/wd10/form">DBRA Report of Construction Contractor’s Wage Rates </a>(Form Number - WH-10; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-913.pdf">Description Of Coal Mine Work and Other Employment</a> (Form Number - CM-913; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-40.pdf">Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a</a> (Form Number - CA-40; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-232.pdf">Domestic Agricultural In- Season Wage Report</a> (Form Number - 232; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ET_385_Wage_Finding_Process.pdf">Domestic Agricultural In-season Wage Finding Process</a> (Form Number - 385; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-17.pdf">Duty Status Report</a> (Form Number - CA-17; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/regs/compliance/ca-17_ES.pdf">Informe de estado de servicio (Número de formulario - CA-17; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/electrically-operated-equipment-field-approval">Electrically Operated Equipment Field Approval Application (Coal Only)</a> (Form Number - 2000-38; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2017/01/23/electronic-training-plan-advisor">Electronic Training Plan Advisor</a> (Form Number - N/A; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-1.pdf">Employee's Claim</a> (Form Number - EE-1; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-203.pdf">Employee's Claim for Compensation</a> (Form Number - LS-203; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM10">Employer Report</a> (Form Number - LM-10; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/Form_ETA-9165_rev_DOL_Appropriations_Act.pdf">Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey</a> (Form Number - 9165; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-202.pdf">Employer's First Report of Injury or Occupational Illness</a> (Form Number - LS-202; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-210.pdf">Employer's Supplementary Report of Accident or Occupational Illness</a> (Form Number - LS-210; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9033A.pdf">Employers’ Attestation to Use Alien Crewmembers for Longshore Activities in the State of Alaska</a> (Form Number - 9033-A; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9033.pdf">Employers’ Attestation to Use Alien Crewmembers for Longshore Activities in U.S. Ports Form ETA 9033</a> (Form Number - 9033; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-911a.pdf">Employment History</a> (Form Number - CM-911a; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-3.pdf">Employment History</a> (Form Number - EE-3; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-4.pdf">Employment History Affidavit</a> (Form Number - EE-4; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH1481.pdf">EPPA Notice to Examinee</a> (Form Number - WH-1481; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-35.pdf">Evidence Required in Support of a Claim for Occupational Disease</a> (Form Number - CA-35; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/agencies/ofccp/contact/file-complaint">Federal Contractor Discrimination Complaint</a> (Form Number - N/A; Agency - Office of Federal Contract Compliance Programs)</li><li><a href="https://www.dol.gov/agencies/vets/programs/vets4212">Federal Contractor Reporting - Veteran Hiring</a> (Form Number - VETS-4212; Agency - Veterans' Employment and Training Service)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1.pdf">Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation</a> (Form Number - CA-1; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH385V.pdf">FMLA Certification for Serious Injury or Illness of a Veteran for Wage and Hour Division Military Caregiver Leave</a> (Form Number - WH-385V; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-385.pdf">FMLA Certification for Serious Injury orIllness of Covered Servicemember -- for Military Family Leave</a> (Form Number - WH-385; Agency - Wage and Hour Division)</li><li><p><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-E.pdf">FMLA Certification of Health Care Providerfor Employee’s Serious Health Condition</a> (Form Number - WH-380-E; Agency - Wage and Hour Division)</p><p><em><strong>This form can't be completed online. It can be downloaded and completed with Adobe's free Acrobat Reader.</strong></em> Use when a leave request is due to the medical condition of the employee.</p></li><li><p><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-F.pdf">FMLA Certification of Health Care Providerfor Family Member’s Serious Health Condition</a> (Form Number - WH-380-F; Agency - Wage and Hour Division)</p><p><em><strong>This form can't be completed online. It can be downloaded and completed with Adobe's free Acrobat Reader. </strong></em>Use when a leave request is due to the medical condition of the employee’s family member.</p></li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-384.pdf">FMLA Certification of Qualifying Exigency For Military Family Leave</a> (Form Number - WH-384; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-382.pdf">FMLA Designation Notice</a> (Form Number - WH-382 ; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-381.pdf">FMLA Notice of Eligibility and Rights & Responsibilities</a> (Form Number - WH-381; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_9127.pdf">Foreign Labor Certification Quarterly Activity Report</a> (Form Number - 9127; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-4.pdf">H-1B Nonimmigrant Information</a> (Form Number - WH-4; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9142A.pdf">H-2A Application for Temporary Employment Certification</a> (Form Number - 9142A; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9142B.pdf">H-2B Application for Temporary Employment Certification</a> (Form Number - 9142B; Agency - Employment and Training Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/hazardous-condition-complaint">Hazardous Condition Complaint</a> (Form Number - N/A; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/health-activity-certification-or-hoisting-engineers">Health Activity Certification or Hoisting Engineers Qualification Request</a> (Form Number - 5000-41; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1500.pdf">Health Insurance Claim Form</a> (Form Number - OWCP-1500; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-201.pdf">Higher Education to Employ its Full-time Students at Subminimum Wages Under Regulations 29 C.F.R. Part 519</a> (Form Number - WH-201; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH75EN.pdf">Homeworker Handbook </a>(Form Number - WH-75; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH75SP.pdf">Homeworker Handbook (Spanish)</a> (Form Number - WH-75; Agency - Wage and Hour Division)</li><li><a href="https://www.oig.dol.gov/hotlinemain.htm">Inspector General Hotline</a> (Form Number - N/A; Agency - Office of Inspector General)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-921.pdf">Instructions For Completion of Form CM-921</a> (Form Number - CM-921; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">Labor Organization Annual Report</a> (Form Number - LM-2; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">Labor Organization Annual Report </a>(Form Number - LM-3; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">Labor Organization Annual Report </a>(Form Number - LM-4; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM1">Labor Organization Information Report</a> (Form Number - LM-1; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM30">Labor Organization Officer and Employee Report</a> (Form Number - LM-30; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.foreignlaborcert.doleta.gov/preh1bform.cfm">LCA Online Application</a> (Form Number - 9035; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7b.pdf">Leave Buy Back (LBB) Worksheet/Certification and Election</a> (Form Number - CA-7b; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/legal-identification-report">Legal Identification Report</a> (Form Number - 2000-7; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1031.pdf">Letter to Dependants to Verify Claimant Support</a> (Form Number - CA-1031; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1074.pdf">Letter to Parents in Death Claim Development</a> (Form Number - CA-1074; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/LONGSHORE/REFERENCES/FORMS/OALJ_PREHEARING_STATEMENT_FY16.PDF">LHWCA Prehearing Statement Form</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/LONGSHORE/REFERENCES/FORMS/LHC_STIPULATIONS_FORM_JUNE_04_2008.PDF">LHWCA Uniform Stipulations Form</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/manageupdate-diesel-inventory">Manage/Update Diesel Inventory</a> (Form Number - N/A; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-988.pdf">Medical History and Examination for Coal Mine Workers' Pneumoconiosis</a> (Form Number - CM-988; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-7.pdf">Medical Requirements</a> (Form Number - EE-7; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/OWCP/regs/compliance/OWCP-957A.pdf">Medical Travel Refund Request</a> – Mileage (Form Number - OWCP-957A; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/OWCP/regs/compliance/OWCP-957B.pdf">Medical Travel Refund Request</a> – Expenses (Form Number - OWCP-957B; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/14/mine-accident-injury-and-illness-report">Mine Accident, Injury and Illness Report</a> (Form Number - 7000-1; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/mine-id-request">Mine ID Request</a> (Form Number - 7000-51; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-911.pdf">Miner's Claim For Benefits Under The Black Lung Benefits Act</a> (Form Number - CM-911; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="/sites/dolgov/files/WHD/mspa/wh530.pdf">MSPA Application for a Farm Labor Contractor or Farm Labor ContractorEmployee Certificate of Registration</a> (Form Number - WH-530; Agency - Wage and Hour Division)</li><li><a href="/sites/dolgov/files/WHD/mspa/wh-530_sp.pdf">MSPA Application for a Farm Labor Contractor or Farm Labor ContractorEmployee Certificate of Registration (Spanish)</a> (Form Number - WH-530; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh515.pdf">MSPA Doctor’s Certificate</a> (Form Number - WH-515; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh520.pdf">MSPA Housing Occupancy Certificate</a> (Form Number - WH-520; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh521.pdf">MSPA Housing Terms and Conditions</a> (Form Number - WH-521; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh514.pdf">MSPA Vehicle Mechanical Inspection Report for Transportation Subjectto Department of Transportation Requirements </a>(Form Number - WH-514; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/Form_WH-501.PDF">MSPA Wage Statement</a> (Form Number - WH-501; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/Form_WH-501S.PDF">MSPA Wage Statement (Spanish)</a> (Form Number - WH-501; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh516.pdf">MSPA Worker Information – Terms of Employment </a>(Form Number - WH-516; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH516HaitianCreole.pdf">MSPA Worker Information – Terms of Employment (Haitian Creole)</a> (Form Number - WH-516; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-516_Spanish.PDF">MSPA Worker Information – Terms of Employment (Spanish)</a> (Form Number - WH-516; Agency - Wage and Hour Division)</li><li><a href="https://www.askebsa.dol.gov/mewa/">Multiple Employer Welfare Arrangements (MEWAs) Annual Report</a> (Form Number - M-1; Agency - Employee Benefits Security Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-207.pdf">Notice of Controversion of Right to Compensation</a> (Form Number - LS-207; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-201.pdf">Notice of Employee's Injury or Death</a> (Form Number - LS-201; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-208.pdf">Notice of Final Payment or Suspension of Compensation Payments</a> (Form Number - LS-208; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-722.pdf">Notice of Law Enforcement Officer's Death</a> (Form Number - CA-722; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-721.pdf">Notice of Law Enforcement Officer's Injury Or Occupational Disease</a> (Form Number - CA-721; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2.pdf">Notice of Occupational Disease and Claim for Compensation</a> (Form Number - CA-2; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2a.pdf">Notice of Recurrence</a> (Form Number - CA-2a; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-908.pdf">Notice of Termination, Suspension, Reduction or Increase in Benefit Payments</a> (Form Number - CM-908; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-42.pdf">Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity</a> (Form Number - CA-42; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-6.pdf">Official Supervisor's Report of Employee's Death</a> (Form Number - CA-6; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2970a.pdf">Operator Response to Notice of Claim</a> (Form Number - CM-2970a; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2970.pdf">Operator Response to Schedule for Submission of Additional Evidence</a> (Form Number - CM-2970; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/11/18/operator%E2%80%99s-annual-certification-mine-rescue-teams">Operator’s Annual Certification of Mine Rescue Teams Qualifications</a> (Form Number - 2000-224; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_APPOINTMENT_FORM.PDF">Order Appointing Mediator</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-20.pdf">Overpayment Recovery Questionnaire</a> (Form Number - OWCP-20; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-787.pdf">Physician's/Medical Officer's Statement</a> (Form Number - CM-787; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-18.pdf">Pre-Hearing Statement</a> (Form Number - LS-18; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1168.pdf">Provider Enrollment form</a> (Form Number - OWCP-1168; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/quarterly-mine-employment-and-coal-production">Quarterly Mine Employment and Coal Production Report</a> (Form Number - 7000-2; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM21">Receipts and Disbursements Report</a> (Form Number - LM-21; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/record-individual-exposure-radon-daughters">Record of Individual Exposure to Radon Daughters</a> (Form Number - 4000-9; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-44.pdf">Rehabilitation Action Report</a> (Form Number - OWCP-44; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-17.pdf">Rehabilitation Maintenance Certificate</a> (Form Number - OWCP-17; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-16.pdf">Rehabilitation Plan And Award</a> (Form Number - OWCP-16; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/report-commencementclosure-operation-%E2%80%93-metal-and">Report Commencement/Closure of Operation – Metal and Nonmetal Mines</a> (Form Number - N/A; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-1159.pdf">Report of Arterial Blood Gas Study</a> (Form Number - CM-1159; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-929.pdf">Report of Changes That May Affect Your Black Lung Benefits</a> (Form Number - CM-929; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-929P.pdf">Report of Changes That May Affect Your Black Lung Benefits</a> (Form Number - CM-929P; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-200.pdf">Report of Earnings</a> (Form Number - LS-200; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-274.pdf">Report of Injury Experience of Insurance Carrier or Self-Insured Employer</a> (Form Number - LS-274; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-513.pdf">Report of Payments.</a> (Form Number - LS-513; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2907.pdf">Report of Ventilatory Study</a> (Form Number - CM-2907; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM15a">Report on Selection of Delegates and Officers</a> (Form Number - LM-15A; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/representative-miners-designation-form">Representative of Miners Designation Form</a> (Form Number - 2000-238; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-623.pdf">Representative Payee Report</a> (Form Number - CM-623; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-623s.pdf">Representative Payee Report</a> (Form Number - CM-623S; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/request-msha-individual-identification-number-miin">Request an MSHA Individual Identification Number (MIIN)</a> (Form Number - 5000-46; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_REQUEST_FORM_2019.pdf">Request for Appointment of Mediator</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-426.pdf">Request for Earnings Information</a> (Form Number - LS-426; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-1.pdf">Request for Examination and/or Treatment</a> (Form Number - LS-1; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7.pdf">Request for Intervention</a> (Form Number - LS-7; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-910.pdf">Request To Be Selected As Payee</a> (Form Number - CM-910; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-933.pdf">Roentgenographic Interpretation</a> (Form Number - CM-933; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-933b.pdf">Roentgenographic Quality Rereading</a> (Form Number - CM-933b; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.osha.gov/pls/osha7/eComplaintForm.html">Safety and Health Complaint</a> (Form Number - N/A; Agency - Occupational Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/self-contained-self-rescuer-scsr-inventory-and">Self Contained Self Rescuer (SCSR) Inventory and Report</a> (Form Number - 2000-222; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8.pdf">Settlement Approval Request Section 8(i)</a> (Form Number - LS-8; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/SETTLEMENT_JUDGE_REQUEST_FORM.PDF">Settlement Judge Request</a> (Form Number - N/A; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1108.pdf">Statement of Recovery Letter with Long Form</a> (Form Number - CA-1108; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1122.pdf">Statement of Recovery Letter with Short Form</a> (Form Number - CA-1122; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9.pdf">Stipulation Approval Request</a> (Form Number - LS-9; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226a.pdf">Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Subminimum Wages</a> (Form Number - WH-226A; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLMS1">Surety Company Annual Report</a> (Form Number - S-1; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-2.pdf">Survivor's Claim</a> (Form Number - EE-2; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-912.pdf">Survivor's Form For Benefits Under The Black Lung Benefits Act</a> (Form Number - CM-912; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM16">Terminal Trusteeship Report</a> (Form Number - LM-16; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7a.pdf">Time Analysis Form, used for claiming compensation, including repurchase of paid leave</a> (Form Number - CA-7a; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM15">Trusteeship Report</a> (Form Number - LM-15; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-04.pdf">Uniform Billing Form</a> (Form Number - OWCP-04; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/agencies/whd/contact/complaints">Wage Complaints</a> (Form Number - N/A; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-232A.pdf">Wage Survey Interview Record</a> (Form Number - 232A; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-802.pdf">Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives</a> (Form Number - LS-802; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-801.pdf">Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers</a> (Form Number - LS-801; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/OWCP/regs/compliance/CA-10.pdf">What A Federal Employee Should Do When Injured At Work</a> (Form Number - CA-10; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5b.pdf">Work Capacity Evaluation Cardiovascular/Pulmonary Conditions</a> (Form Number - OWCP-5b; Agency - Office of Workers' Compensation Programs)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5b_ES.pdf">Evaluación de la capacidad de trabajo Condiciones cardiovasculares / pulmonares (Número de formulario - OWCP-5b; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5c.pdf">Work Capacity Evaluation for Musculoskeletal Conditions</a> (Form Number - OWCP-5c; Agency - Office of Workers' Compensation Programs)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5c_ES.pdf">Evaluación de la capacidad de trabajo Condiciones músculo esqueléticas (Número de formulario -  OWCP-5c; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5a.pdf">Work Capacity Evaluation Psychiatric/Psychological Conditions</a> (Form Number - OWCP-5a; Agency - Office of Workers' Compensation Programs)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5a_ES.pdf">Evaluación de la capacidad de trabajo Condiciones psiquiátricas / psicológicas (Número de formulario - OWCP-5a; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion2"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a2"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Forms by Number</div> </button> </span> <div id="a2" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-232.pdf">232</a> (Form Name - Domestic Agricultural In- Season Wage Report; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-232A.pdf">232A</a> (Form Name - Wage Survey Interview Record; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ET_385_Wage_Finding_Process.pdf">385</a> (Form Name - Domestic Agricultural In-season Wage Finding Process; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-Form_750-PartA_508_Compliant.pdf">750A</a> (Form Name - Application for Alien Employment Certification - Part A; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-Form_750-PartB_508_Compliant.pdf">750B</a> (Form Name - Application for Alien Employment Certification - Part B; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/mas/pdfs/790.pdf">790</a> (Form Name - Agricultural and Food Processing Clearance Order; Agency - Employment and Training Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/legal-identification-report">2000-7</a> (Form Name - Legal Identification Report; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/electrically-operated-equipment-field-approval">2000-38</a> (Form Name - Electrically Operated Equipment Field Approval Application (Coal Only); Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/self-contained-self-rescuer-scsr-inventory-and">2000-222</a> (Form Name - Self Contained Self Rescuer (SCSR) Inventory and Report; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/11/18/operator%E2%80%99s-annual-certification-mine-rescue-teams">2000-224</a> (Form Name - Operator’s Annual Certification of Mine Rescue Teams Qualifications; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/representative-miners-designation-form">2000-238</a> (Form Name - Representative of Miners Designation Form; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/record-individual-exposure-radon-daughters">4000-9</a> (Form Name - Record of Individual Exposure to Radon Daughters; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training">5000-1</a> (Form Name - Certificate of Electrical/Noise Training; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-physical-qualification-mine-rescue-work">5000-3</a> (Form Name - Certificate of Physical Qualification for Mine Rescue Work; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/certificate-training">5000-23</a> (Form Name - Certificate of Training; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/health-activity-certification-or-hoisting-engineers">5000-41</a> (Form Name - Health Activity Certification or Hoisting Engineers Qualification Request; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/request-msha-individual-identification-number-miin">5000-46</a> (Form Name - Request an MSHA Individual Identification Number (MIIN); Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/reporting-and-filing/form-5500">5500</a> (Form Name - 5500 Series; Agency - Employee Benefits Security Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/14/mine-accident-injury-and-illness-report">7000-1</a> (Form Name - Mine Accident, Injury and Illness Report; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/quarterly-mine-employment-and-coal-production">7000-2</a> (Form Name - Quarterly Mine Employment and Coal Production Report; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/mine-id-request">7000-51</a> (Form Name - Mine ID Request; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/contractor-id-request">7000-52</a> (Form Name - Contractor ID Request; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/mas/pdfs/Complaint_Apparent_Violation_Form_8429.pdf">8429</a> (Form Name - Complaint/Apparent Violation Form; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9033.pdf">9033</a> (Form Name - Employers’ Attestation to Use Alien Crewmembers for Longshore Activities in U.S. Ports Form ETA 9033; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9033A.pdf">9033-A</a> (Form Name - Employers’ Attestation to Use Alien Crewmembers for Longshore Activities in the State of Alaska; Agency - Employment and Training Administration)</li><li><a href="https://www.foreignlaborcert.doleta.gov/preh1bform.cfm">9035</a> (Form Name - LCA Online Application; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9089form.pdf">9089</a> (Form Name - Application for Permanent Employment Certification; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_9127.pdf">9127</a> (Form Name - Foreign Labor Certification Quarterly Activity Report; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9141.pdf">9141</a> (Form Name - Application for Prevailing Wage Determination; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9141C.pdf">9141C</a> (Form Name - Application for Prevailing Wage Determination; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9142A.pdf">9142A</a> (Form Name - H-2A Application for Temporary Employment Certification; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9142B.pdf">9142B</a> (Form Name - H-2B Application for Temporary Employment Certification; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9142C.pdf">9142C</a> (Form Name - CW-1 Application for Temporary Employment Certification; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/Form_ETA-9165_rev_DOL_Appropriations_Act.pdf">9165</a> (Form Name - Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey; Agency - Employment and Training Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/ecab/ab-1.pdf">AB-1</a> (Form Name - Appeal Form; Agency - Employees' Compensation Appeals Board)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1.pdf">CA-1</a> (Form Name - Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2.pdf">CA-2</a> (Form Name - Notice of Occupational Disease and Claim for Compensation; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2a.pdf">CA-2a</a> (Form Name - Notice of Recurrence; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-5.pdf">CA-5</a> (Form Name - Claim for Compensation by Widow, Widower, and/or Children; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-5b.pdf">CA-5b</a> (Form Name - Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-6.pdf">CA-6</a> (Form Name - Official Supervisor's Report of Employee's Death; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7.pdf">CA-7</a> (Form Name - Claim for Compensation; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7a.pdf">CA-7a</a> (Form Name - Time Analysis Form, used for claiming compensation, including repurchase of paid leave; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7b.pdf">CA-7b</a> (Form Name - Leave Buy Back (LBB) Worksheet/Certification and Election; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/OWCP/regs/compliance/CA-10.pdf">CA-10</a> (Form Name - What A Federal Employee Should Do When Injured At Work; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-12.pdf">CA-12</a> (Form Name - Claim For Continuance of Compensation Under the Federal Employees' Compensation Act; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-17.pdf">CA-17</a> (Form Name - Duty Status Report; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/regs/compliance/ca-17_ES.pdf">Informe de estado de servicio (Número de formulario - CA-17; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-20.pdf">CA-20</a> (Form Name - Attending Physician's Report; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/regs/compliance/ca-20_ES.pdf">Informe del médico tratante (Número de formulario - CA-20; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-35.pdf">CA-35</a> (Form Name - Evidence Required in Support of a Claim for Occupational Disease; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-40.pdf">CA-40</a> (Form Name - Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-41.pdf">CA-41</a> (Form Name - Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-42.pdf">CA-42</a> (Form Name - Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-278.pdf">CA-278</a> (Form Name - Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-721.pdf">CA-721</a> (Form Name - Notice of Law Enforcement Officer's Injury Or Occupational Disease; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-722.pdf">CA-722</a> (Form Name - Notice of Law Enforcement Officer's Death; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1031.pdf">CA-1031</a> (Form Name - Letter to Dependants to Verify Claimant Support; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1074.pdf">CA-1074</a> (Form Name - Letter to Parents in Death Claim Development; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1108.pdf">CA-1108</a> (Form Name - Statement of Recovery Letter with Long Form; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1122.pdf">CA-1122</a> (Form Name - Statement of Recovery Letter with Short Form; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2231.pdf">CA-2231</a> (Form Name - Claim for Reimbursement Assisted Reemployment; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-623.pdf">CM-623</a> (Form Name - Representative Payee Report; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-787.pdf">CM-787</a> (Form Name - Physician's/Medical Officer's Statement; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-893.pdf">CM-893</a> (Form Name - Certificate of Medical Necessity; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-908.pdf">CM-908</a> (Form Name - Notice of Termination, Suspension, Reduction or Increase in Benefit Payments; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-910.pdf">CM-910</a> (Form Name - Request To Be Selected As Payee; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-911.pdf">CM-911</a> (Form Name - Miner's Claim For Benefits Under The Black Lung Benefits Act; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-911a.pdf">CM-911a</a> (Form Name - Employment History; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-912.pdf">CM-912</a> (Form Name - Survivor's Form For Benefits Under The Black Lung Benefits Act; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-913.pdf">CM-913</a> (Form Name - Description Of Coal Mine Work and Other Employment; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-921.pdf">CM-921</a> (Form Name - Instructions For Completion of Form CM-921; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-929.pdf">CM-929</a> (Form Name - Report of Changes That May Affect Your Black Lung Benefits; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-929P.pdf">CM-929P</a> (Form Name - Report of Changes That May Affect Your Black Lung Benefits; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-933.pdf">CM-933</a> (Form Name - Roentgenographic Interpretation; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-933b.pdf">CM-933b</a> (Form Name - Roentgenographic Quality Rereading; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-936.pdf">CM-936</a> (Form Name - Authorization For Release Of Medical Information (Black Lung Benefits); Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-972.pdf">CM-972</a> (Form Name - Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-981.pdf">CM-981</a> (Form Name - Certification by School Official; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-988.pdf">CM-988</a> (Form Name - Medical History and Examination for Coal Mine Workers' Pneumoconiosis; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-1159.pdf">CM-1159</a> (Form Name - Report of Arterial Blood Gas Study; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2907.pdf">CM-2907</a> (Form Name - Report of Ventilatory Study; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2970.pdf">CM-2970</a> (Form Name - Operator Response to Schedule for Submission of Additional Evidence; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2970a.pdf">CM-2970a</a> (Form Name - Operator Response to Notice of Claim; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-623s.pdf">CM-623S</a> (Form Name - Representative Payee Report; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-1.pdf">EE-1</a> (Form Name - Employee's Claim; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-2.pdf">EE-2</a> (Form Name - Survivor's Claim; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-3.pdf">EE-3</a> (Form Name - Employment History; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-4.pdf">EE-4</a> (Form Name - Employment History Affidavit; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-7.pdf">EE-7</a> (Form Name - Medical Requirements; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM1">LM-1</a> (Form Name - Labor Organization Information Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">LM-2</a> (Form Name - Labor Organization Annual Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">LM-3</a> (Form Name - Labor Organization Annual Report ; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">LM-4</a> (Form Name - Labor Organization Annual Report ; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM10">LM-10</a> (Form Name - Employer Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM15">LM-15</a> (Form Name - Trusteeship Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM15a">LM-15A</a> (Form Name - Report on Selection of Delegates and Officers; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM16">LM-16</a> (Form Name - Terminal Trusteeship Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM20">LM-20</a> (Form Name - Agreement and Activities Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM21">LM-21</a> (Form Name - Receipts and Disbursements Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM30">LM-30</a> (Form Name - Labor Organization Officer and Employee Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-1.pdf">LS-1</a> (Form Name - Request for Examination and/or Treatment; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4.pdf">LS-4</a> (Form Name - Attorney Fee Approval Request; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5.pdf">LS-5</a> (Form Name - Application For Special Relief Fund; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6.pdf">LS-6</a> (Form Name - Commutation Application; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7.pdf">LS-7</a> (Form Name - Request for Intervention; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8.pdf">LS-8</a> (Form Name - Settlement Approval Request Section 8(i); Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9.pdf">LS-9</a> (Form Name - Stipulation Approval Request; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-18.pdf">LS-18</a> (Form Name - Pre-Hearing Statement; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-33.pdf">LS-33</a> (Form Name - Approval of Compromise of Third Person Cause of Action; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-200.pdf">LS-200</a> (Form Name - Report of Earnings; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-201.pdf">LS-201</a> (Form Name - Notice of Employee's Injury or Death; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-202.pdf">LS-202</a> (Form Name - Employer's First Report of Injury or Occupational Illness; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-203.pdf">LS-203</a> (Form Name - Employee's Claim for Compensation; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-204.pdf">LS-204</a> (Form Name - Attending Physician's Supplementary Report; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-207.pdf">LS-207</a> (Form Name - Notice of Controversion of Right to Compensation; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-208.pdf">LS-208</a> (Form Name - Notice of Final Payment or Suspension of Compensation Payments; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-210.pdf">LS-210</a> (Form Name - Employer's Supplementary Report of Accident or Occupational Illness; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-262.pdf">LS-262</a> (Form Name - Claim for Death Benefits; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-265.pdf">LS-265</a> (Form Name - Certification of Funeral Expenses; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-266.pdf">LS-266</a> (Form Name - Application for Continuation of Death Benefit for Student; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-267.pdf">LS-267</a> (Form Name - Claimant's Statement; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-271.pdf">LS-271</a> (Form Name - Application for Self-Insurance instructions; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-272.pdf">LS-272</a> (Form Name - Application to write Longshore Insurance (Carriers); Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-274.pdf">LS-274</a> (Form Name - Report of Injury Experience of Insurance Carrier or Self-Insured Employer; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-275ic.pdf">LS-275ic</a> (Form Name - Agreement and Undertaking (Insurance Carrier); Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-275si.pdf">LS-275si</a> (Form Name - Agreement and Undertaking (Self-Insured Employer); Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-276.pdf">LS-276</a> (Form Name - Application for Security Deposit Determination. State Guarantee Fund Longshore Security Factor Chart; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-426.pdf">LS-426</a> (Form Name - Request for Earnings Information; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-513.pdf">LS-513</a> (Form Name - Report of Payments.; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-570.pdf">LS-570</a> (Form Name - Carrier's Report of Issuance of Policy (formerly Card Report of Insurance); Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-801.pdf">LS-801</a> (Form Name - Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-802.pdf">LS-802</a> (Form Name - Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives; Agency - Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation)</li><li><a href="https://www.askebsa.dol.gov/mewa/">M-1</a> (Form Name - Multiple Employer Welfare Arrangements (MEWAs) Annual Report; Agency - Employee Benefits Security Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_APPEAR_AND_TESTIFY_DEPOSITION_04_2020_EMAIL_PROCESSING.PDF">N/A</a> (Form Name - Administrative Subpoena to Appear & Testify at a Deposition; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_APPEAR_AND_TESTIFY_HEARING_04_2020_EMAIL_PROCESSING.PDF">N/A</a> (Form Name - Administrative Subpoena to Appear & Testify at a Hearing; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_PRODUCE_DOCUMENTS_PERMIT_INSPECTION_OALJ_04_2020_EMAIL_PROCESSING.PDF">N/A</a> (Form Name - Administrative Subpoena to Produce Documents, Information or Objects, or to Permit Inspection of Premises; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_AGREEMENT_TO_MEDIATE_FORM_REVISED_04_11_2018.PDF">N/A</a> (Form Name - Agreement to Mediate; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/BLACK_LUNG/REFERENCES/FORMS/USDOL_OALJ_BLBA_EVIDENCE_SUMMARY_FORM_01_2003.PDF">N/A</a> (Form Name - Black Lung Benefits Act Evidence Summary Form; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.msha.gov/certificates-achievement-safety">N/A</a> (Form Name - Certificates of Achievement in Safety; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2017/01/23/electronic-training-plan-advisor">N/A</a> (Form Name - Electronic Training Plan Advisor; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/agencies/ofccp/contact/file-complaint">N/A</a> (Form Name - Federal Contractor Discrimination Complaint; Agency - Office of Federal Contract Compliance Programs)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/hazardous-condition-complaint">N/A</a> (Form Name - Hazardous Condition Complaint; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.oig.dol.gov/hotlinemain.htm">N/A</a> (Form Name - Inspector General Hotline; Agency - Office of Inspector General)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/LONGSHORE/REFERENCES/FORMS/OALJ_PREHEARING_STATEMENT_FY16.PDF">N/A</a> (Form Name - LHWCA Prehearing Statement Form; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/LONGSHORE/REFERENCES/FORMS/LHC_STIPULATIONS_FORM_JUNE_04_2008.PDF">N/A</a> (Form Name - LHWCA Uniform Stipulations Form; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/manageupdate-diesel-inventory">N/A</a> (Form Name - Manage/Update Diesel Inventory; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_APPOINTMENT_FORM.PDF">N/A</a> (Form Name - Order Appointing Mediator; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/report-commencementclosure-operation-%E2%80%93-metal-and">N/A</a> (Form Name - Report Commencement/Closure of Operation – Metal and Nonmetal Mines; Agency - Mine Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_REQUEST_FORM_2019.pdf">N/A</a> (Form Name - Request for Appointment of Mediator; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.osha.gov/pls/osha7/eComplaintForm.html">N/A</a> (Form Name - Safety and Health Complaint; Agency - Occupational Safety and Health Administration)</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/SETTLEMENT_JUDGE_REQUEST_FORM.PDF">N/A</a> (Form Name - Settlement Judge Request; Agency - Office of Administrative Law Judges)</li><li><a href="https://www.dol.gov/agencies/whd/contact/complaints">N/A</a> (Form Name - Wage Complaints; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1.pdf">OWCP-01</a> (Form Name - Agreement and Undertaking (Self-Insured Employer; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-04.pdf">OWCP-04</a> (Form Name - Uniform Billing Form; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5a.pdf">OWCP-5a</a> (Form Name - Work Capacity Evaluation Psychiatric/Psychological Conditions; Agency - Office of Workers' Compensation Programs)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5a_ES.pdf">Evaluación de la capacidad de trabajo Condiciones psiquiátricas / psicológicas (Número de formulario - OWCP-5a; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5b.pdf">OWCP-5b</a> (Form Name - Work Capacity Evaluation Cardiovascular/Pulmonary Conditions; Agency - Office of Workers' Compensation Programs)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5b_ES.pdf">Evaluación de la capacidad de trabajo Condiciones cardiovasculares / pulmonares (Número de formulario - OWCP-5b; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5c.pdf">OWCP-5c</a> (Form Name - Work Capacity Evaluation for Musculoskeletal Conditions; Agency - Office of Workers' Compensation Programs)<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5c_ES.pdf">Evaluación de la capacidad de trabajo Condiciones músculo esqueléticas (Número de formulario -  OWCP-5c; Agencia - Oficina de Programas de Compensación para Trabajadores - La División de Compensación para Trabajadores Federales, Estibadores y Portuarios)</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-16.pdf">OWCP-16</a> (Form Name - Rehabilitation Plan And Award; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-17.pdf">OWCP-17</a> (Form Name - Rehabilitation Maintenance Certificate; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-20.pdf">OWCP-20</a> (Form Name - Overpayment Recovery Questionnaire; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-44.pdf">OWCP-44</a> (Form Name - Rehabilitation Action Report; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-915.pdf">OWCP-915</a> (Form Name - Claim For Medical Reimbursement; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/OWCP/regs/compliance/OWCP-957A.pdf">OWCP-957A</a> – (Form Name - Medical Travel Refund Request – Mileage; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/OWCP/regs/compliance/OWCP-957B.pdf">OWCP-957B</a> – (Form Name - Medical Travel Refund Request – Expenses; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1168.pdf">OWCP-1168</a> (Form Name - Provider Enrollment form; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1500.pdf">OWCP-1500</a> (Form Name - Health Insurance Claim Form; Agency - Office of Workers' Compensation Programs)</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLMS1">S-1</a> (Form Name - Surety Company Annual Report; Agency - Office of Labor-Management Standards)</li><li><a href="https://www.dol.gov/agencies/vets/programs/vets4212">VETS-4212</a> (Form Name - Federal Contractor Reporting - Veteran Hiring; Agency - Veterans' Employment and Training Service)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-2.pdf">WH-2</a> (Form Name - Application for Special Industrial Homeworker Certificate; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-4.pdf">WH-4</a> (Form Name - H-1B Nonimmigrant Information; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-5.pdf">WH-5</a> (Form Name - Certificate of Training Form; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/agencies/whd/government-contracts/construction/surveys/wd10/form">WH-10</a> (Form Name - DBRA Report of Construction Contractor’s Wage Rates ; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-46.pdf">WH-46</a> (Form Name - Application for Certificateto Employ Homeworkers; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH75EN.pdf">WH-75</a> (Form Name - Homeworker Handbook ; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH75SP.pdf">WH-75</a> (Form Name - Homeworker Handbook (Spanish); Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-200.pdf">WH-200</a> (Form Name - Application for Authority to Employ Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture Under Regulations 29 C.F.R. Part 519; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-201.pdf">WH-201</a> (Form Name - Higher Education to Employ its Full-time Students at Subminimum Wages Under Regulations 29 C.F.R. Part 519; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-202.pdf">WH-202</a> (Form Name - Application for Authority to Employ Six or Fewer Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture Under Regulations 29 C.F.R. Part 519; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-205.pdf">WH-205</a> (Form Name - Application to Employ Student-Learners at Subminimum Wages; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226.pdf">WH-226 </a>(Form Name - Application for Authority to Employ Workers with Disabilities at Subminimum Wages; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226a.pdf">WH-226A</a> (Form Name - Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Subminimum Wages; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh347.pdf">WH-347</a> (Form Name - DBRA Certified Payroll Form; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-E.pdf">WH-380-E</a> (Form Name - FMLA Certification of Health Care Providerfor Employee’s Serious Health Condition; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-F.pdf">WH-380-F</a> (Form Name - FMLA Certification of Health Care Providerfor Family Member’s Serious Health Condition; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-381.pdf">WH-381</a> (Form Name - FMLA Notice of Eligibility and Rights & Responsibilities; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-382.pdf">WH-382 </a>(Form Name - FMLA Designation Notice; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-384.pdf">WH-384</a> (Form Name - FMLA Certification of Qualifying Exigency For Military Family Leave; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-385.pdf">WH-385</a> (Form Name - FMLA Certification for Serious Injury orIllness of Covered Servicemember -- for Military Family Leave; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH385V.pdf">WH-385V</a> (Form Name - FMLA Certification for Serious Injury or Illness of a Veteran for Wage and Hour Division Military Caregiver Leave; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/Form_WH-501.PDF">WH-501</a> (Form Name - MSPA Wage Statement; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/Form_WH-501S.PDF">WH-501</a> (Form Name - MSPA Wage Statement (Spanish); Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh514.pdf">WH-514</a> (Form Name - MSPA Vehicle Mechanical Inspection Report for Transportation Subjectto Department of Transportation Requirements ; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh515.pdf">WH-515</a> (Form Name - MSPA Doctor’s Certificate; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh516.pdf">WH-516</a> (Form Name - MSPA Worker Information – Terms of Employment ; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH516HaitianCreole.pdf">WH-516</a> (Form Name - MSPA Worker Information – Terms of Employment (Haitian Creole); Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-516_Spanish.PDF">WH-516</a> (Form Name - MSPA Worker Information – Terms of Employment (Spanish); Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh520.pdf">WH-520</a> (Form Name - MSPA Housing Occupancy Certificate; Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh521.pdf">WH-521</a> (Form Name - MSPA Housing Terms and Conditions; Agency - Wage and Hour Division)</li><li><a href="/sites/dolgov/files/WHD/mspa/wh530.pdf">WH-530</a> (Form Name - MSPA Application for a Farm Labor Contractor or Farm Labor ContractorEmployee Certificate of Registration; Agency - Wage and Hour Division)</li><li><a href="/sites/dolgov/files/WHD/mspa/wh-530_sp.pdf">WH-530</a> (Form Name - MSPA Application for a Farm Labor Contractor or Farm Labor ContractorEmployee Certificate of Registration (Spanish); Agency - Wage and Hour Division)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH1481.pdf">WH-1481</a> (Form Name - EPPA Notice to Examinee; Agency - Wage and Hour Division)</li></ul></div> </div> </div> </div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--row paragraph--view-mode--default row" style="background-color:;"> <div class="field field--name-field-bundles field--type-entity-reference-revisions field--label-hidden clearfix"> <div> <div class="paragraph paragraph--type--text-block paragraph--view-mode--default"> <div class="field field--name-field-p-text field--type-text-long field--label-hidden clearfix"><h2>Forms By Agency</h2></div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion3"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a3"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Employee Benefits Security Administration</div> </button> </span> <div id="a3" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/agencies/ebsa/employers-and-advisers/plan-administration-and-compliance/reporting-and-filing/form-5500">5500</a> - 5500 Series</li><li><a href="https://www.askebsa.dol.gov/mewa/">M-1</a> - Multiple Employer Welfare Arrangements (MEWAs) Annual Report</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion4"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a4"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Employees' Compensation Appeals Board</div> </button> </span> <div id="a4" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/sites/dolgov/files/ecab/ab-1.pdf">AB-1</a> - Appeal Form</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion5"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a5"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Employment and Training Administration</div> </button> </span> <div id="a5" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-232.pdf">232</a> - Domestic Agricultural In- Season Wage Report</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-232A.pdf">232A</a> - Wage Survey Interview Record</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ET_385_Wage_Finding_Process.pdf">385</a> - Domestic Agricultural In-season Wage Finding Process</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-Form_750-PartA_508_Compliant.pdf">750A</a> - Application for Alien Employment Certification - Part A</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA-Form_750-PartB_508_Compliant.pdf">750B</a> - Application for Alien Employment Certification - Part B</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/mas/pdfs/790.pdf">790</a> - Agricultural and Food Processing Clearance Order</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/mas/pdfs/Complaint_Apparent_Violation_Form_8429.pdf">8429</a> - Complaint/Apparent Violation Form</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9033.pdf">9033</a> - Employers’ Attestation to Use Alien Crewmembers for Longshore Activities in U.S. Ports Form ETA 9033</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9033A.pdf">9033-A</a> - Employers’ Attestation to Use Alien Crewmembers for Longshore Activities in the State of Alaska</li><li><a href="https://www.foreignlaborcert.doleta.gov/preh1bform.cfm">9035</a> - LCA Online Application</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9089form.pdf">9089</a> - Application for Permanent Employment Certification</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_9127.pdf">9127</a> - Foreign Labor Certification Quarterly Activity Report</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9141.pdf">9141</a> - Application for Prevailing Wage Determination</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9141C.pdf">9141C</a> - Application for Prevailing Wage Determination</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9142A.pdf">9142A</a> - H-2A Application for Temporary Employment Certification</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/ETA_Form_9142B.pdf">9142B</a> - H-2B Application for Temporary Employment Certification</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/9142C.pdf">9142C</a> - CW-1 Application for Temporary Employment Certification</li><li><a href="https://www.dol.gov/sites/dolgov/files/ETA/oflc/pdfs/Form_ETA-9165_rev_DOL_Appropriations_Act.pdf">9165</a> - Employer-Provided Survey Attestations to Accompany H-2B Prevailing Wage Determination Request Based on a Non-OES Survey</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion6"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a6"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Mine Safety and Health Administration</div> </button> </span> <div id="a6" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/legal-identification-report">2000-7</a> - Legal Identification Report</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/electrically-operated-equipment-field-approval">2000-38</a> - Electrically Operated Equipment Field Approval Application (Coal Only)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/self-contained-self-rescuer-scsr-inventory-and">2000-222</a> - Self Contained Self Rescuer (SCSR) Inventory and Report</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/11/18/operator%E2%80%99s-annual-certification-mine-rescue-teams">2000-224</a> - Operator’s Annual Certification of Mine Rescue Teams Qualifications</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/representative-miners-designation-form">2000-238</a> - Representative of Miners Designation Form</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/record-individual-exposure-radon-daughters">4000-9</a> - Record of Individual Exposure to Radon Daughters</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-electricalnoise-training">5000-1</a> - Certificate of Electrical/Noise Training</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/certificate-physical-qualification-mine-rescue-work">5000-3</a> - Certificate of Physical Qualification for Mine Rescue Work</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/certificate-training">5000-23</a> - Certificate of Training</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/health-activity-certification-or-hoisting-engineers">5000-41</a> - Health Activity Certification or Hoisting Engineers Qualification Request</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/request-msha-individual-identification-number-miin">5000-46</a> - Request an MSHA Individual Identification Number (MIIN)</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/14/mine-accident-injury-and-illness-report">7000-1</a> - Mine Accident, Injury and Illness Report</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/quarterly-mine-employment-and-coal-production">7000-2</a> - Quarterly Mine Employment and Coal Production Report</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/mine-id-request">7000-51</a> - Mine ID Request</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2015/04/15/contractor-id-request">7000-52</a> - Contractor ID Request</li><li><a href="https://www.msha.gov/certificates-achievement-safety">N/A</a> - Certificates of Achievement in Safety</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2017/01/23/electronic-training-plan-advisor">N/A</a> - Electronic Training Plan Advisor</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/hazardous-condition-complaint">N/A</a> - Hazardous Condition Complaint</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/manageupdate-diesel-inventory">N/A</a> - Manage/Update Diesel Inventory</li><li><a href="https://www.msha.gov/support-resources/forms-online-filing/2018/05/23/report-commencementclosure-operation-%E2%80%93-metal-and">N/A</a> - Report Commencement/Closure of Operation – Metal and Nonmetal Mines</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion7"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a7"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Occupational Safety and Health Administration</div> </button> </span> <div id="a7" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.osha.gov/pls/osha7/eComplaintForm.html">N/A</a> - Safety and Health Complaint</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion8"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a8"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Office of Administrative Law Judges</div> </button> </span> <div id="a8" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_APPEAR_AND_TESTIFY_DEPOSITION_04_2020_EMAIL_PROCESSING.PDF">N/A</a> - Administrative Subpoena to Appear & Testify at a Deposition</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_APPEAR_AND_TESTIFY_HEARING_04_2020_EMAIL_PROCESSING.PDF">N/A</a> - Administrative Subpoena to Appear & Testify at a Hearing</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/ADMINISTRATIVE_SUBPOENA_TO_PRODUCE_DOCUMENTS_PERMIT_INSPECTION_OALJ_04_2020_EMAIL_PROCESSING.PDF">N/A</a> - Administrative Subpoena to Produce Documents, Information or Objects, or to Permit Inspection of Premises</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_AGREEMENT_TO_MEDIATE_FORM_REVISED_04_11_2018.PDF">N/A</a> - Agreement to Mediate</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/BLACK_LUNG/REFERENCES/FORMS/USDOL_OALJ_BLBA_EVIDENCE_SUMMARY_FORM_01_2003.PDF">N/A</a> - Black Lung Benefits Act Evidence Summary Form</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/LONGSHORE/REFERENCES/FORMS/OALJ_PREHEARING_STATEMENT_FY16.PDF">N/A</a> - LHWCA Prehearing Statement Form</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/LONGSHORE/REFERENCES/FORMS/LHC_STIPULATIONS_FORM_JUNE_04_2008.PDF">N/A</a> - LHWCA Uniform Stipulations Form</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_APPOINTMENT_FORM.PDF">N/A</a> - Order Appointing Mediator</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/MEDIATOR_REQUEST_FORM_2019.pdf">N/A</a> - Request for Appointment of Mediator</li><li><a href="https://www.dol.gov/sites/dolgov/files/oalj/PUBLIC/SETTLEMENT_JUDGE_REQUEST_FORM.PDF">N/A</a> - Settlement Judge Request</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion9"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a9"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Office of Federal Contract Compliance Programs</div> </button> </span> <div id="a9" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/agencies/ofccp/contact/file-complaint">N/A</a> - Federal Contractor Discrimination Complaint</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion10"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a10"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Office of Inspector General</div> </button> </span> <div id="a10" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.oig.dol.gov/hotlinemain.htm">N/A</a> - Inspector General Hotline</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion11"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a11"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Office of Labor-Management Standards</div> </button> </span> <div id="a11" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM1">LM-1</a> - Labor Organization Information Report</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">LM-2</a> - Labor Organization Annual Report</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">LM-3</a> - Labor Organization Annual Report</li><li><a href="https://www.dol.gov/agencies/olms/reports/forms/lm-1-lm-2-lm-3-lm-4">LM-4</a> - Labor Organization Annual Report</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM10">LM-10</a> - Employer Report</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM15">LM-15</a> - Trusteeship Report</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM15a">LM-15A</a> - Report on Selection of Delegates and Officers</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM16">LM-16</a> - Terminal Trusteeship Report</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM20">LM-20</a> - Agreement and Activities Report</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM21">LM-21</a> - Receipts and Disbursements Report</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLM30">LM-30</a> - Labor Organization Officer and Employee Report</li><li><a href="https://www.dol.gov/agencies/olms/regs/compliance/GPEA_Forms/blanklmforms#FLMS1">S-1</a> - Surety Company Annual Report</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion12"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a12"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Office of Workers' Compensation Programs</div> </button> </span> <div id="a12" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1.pdf">OWCP-01</a> - Agreement and Undertaking (Self-Insured Employer)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-04.pdf">OWCP-04</a> - Uniform Billing Form</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5a.pdf">OWCP-5a</a> - Work Capacity Evaluation Psychiatric/Psychological Conditions<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5a_ES.pdf">Evaluación de la capacidad de trabajo Condiciones psiquiátricas / psicológicas</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5b.pdf">OWCP-5b</a> - Work Capacity Evaluation Cardiovascular/Pulmonary Conditions<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5b_ES.pdf">Evaluación de la capacidad de trabajo Condiciones cardiovasculares / pulmonares</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-5c.pdf">OWCP-5c</a> - Work Capacity Evaluation for Musculoskeletal Conditions<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/dfec/regs/compliance/owcp-5c_ES.pdf">Evaluación de la capacidad de trabajo Condiciones músculo esqueléticas </a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-16.pdf">OWCP-16</a> - Rehabilitation Plan And Award</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-17.pdf">OWCP-17</a> - Rehabilitation Maintenance Certificate</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-20.pdf">OWCP-20</a> - Overpayment Recovery Questionnaire</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-44.pdf">OWCP-44</a> - Rehabilitation Action Report</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-915.pdf">OWCP-915</a> - Claim For Medical Reimbursement</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-957.pdf">OWCP-957</a> - Medical Travel Refund Request</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1168.pdf">OWCP-1168</a> - Provider Enrollment form</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-1500.pdf">OWCP-1500</a> - Health Insurance Claim Form</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion13"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a13"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation</div> </button> </span> <div id="a13" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-623.pdf">CM-623</a> - Representative Payee Report</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-787.pdf">CM-787</a> - Physician's/Medical Officer's Statement</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-893.pdf">CM-893</a> - Certificate of Medical Necessity</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-908.pdf">CM-908</a> - Notice of Termination, Suspension, Reduction or Increase in Benefit Payments</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-910.pdf">CM-910</a> - Request To Be Selected As Payee</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-911.pdf">CM-911</a> - Miner's Claim For Benefits Under The Black Lung Benefits Act</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-911a.pdf">CM-911a</a> - Employment History</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-912.pdf">CM-912</a> - Survivor's Form For Benefits Under The Black Lung Benefits Act</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-913.pdf">CM-913</a> - Description Of Coal Mine Work and Other Employment</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-921.pdf">CM-921</a> - Instructions For Completion of Form CM-921</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-929.pdf">CM-929</a> - Report of Changes That May Affect Your Black Lung Benefits</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-929P.pdf">CM-929P</a> - Report of Changes That May Affect Your Black Lung Benefits</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-933.pdf">CM-933</a> - Roentgenographic Interpretation</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-933b.pdf">CM-933b</a> - Roentgenographic Quality Rereading</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-936.pdf">CM-936</a> - Authorization For Release Of Medical Information (Black Lung Benefits)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-972.pdf">CM-972</a> - Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-981.pdf">CM-981</a> - Certification by School Official</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-988.pdf">CM-988</a> - Medical History and Examination for Coal Mine Workers' Pneumoconiosis</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-1159.pdf">CM-1159</a> - Report of Arterial Blood Gas Study</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2907.pdf">CM-2907</a> - Report of Ventilatory Study</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2970.pdf">CM-2970</a> - Operator Response to Schedule for Submission of Additional Evidence</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-2970a.pdf">CM-2970a</a> - Operator Response to Notice of Claim</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/cm-623s.pdf">CM-623S</a> - Representative Payee Report</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion14"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a14"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation</div> </button> </span> <div id="a14" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-1.pdf">EE-1</a> - Employee's Claim</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-2.pdf">EE-2</a> - Survivor's Claim</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-3.pdf">EE-3</a> - Employment History</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-4.pdf">EE-4</a> - Employment History Affidavit</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/energy/regs/compliance/EEOICPForms/ee-7.pdf">EE-7</a> - Medical Requirements</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion15"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a15"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Office of Workers' Compensation Programs - Division of Federal Employees', Longshore and Harbor Workers' Compensation</div> </button> </span> <div id="a15" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1.pdf">CA-1</a> - Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2.pdf">CA-2</a> - Notice of Occupational Disease and Claim for Compensation</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2a.pdf">CA-2a</a> - Notice of Recurrence</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-5.pdf">CA-5</a> - Claim for Compensation by Widow, Widower, and/or Children</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-5b.pdf">CA-5b</a> - Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-6.pdf">CA-6</a> - Official Supervisor's Report of Employee's Death</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7.pdf">CA-7</a> - Claim for Compensation</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7a.pdf">CA-7a</a> - Time Analysis Form, used for claiming compensation, including repurchase of paid leave</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7b.pdf">CA-7b</a> - Leave Buy Back (LBB) Worksheet/Certification and Election</li><li><a href="https://www.dol.gov/sites/dolgov/files/OWCP/regs/compliance/CA-10.pdf">CA-10</a> - What A Federal Employee Should Do When Injured At Work</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-12.pdf">CA-12</a> - Claim For Continuance of Compensation Under the Federal Employees' Compensation Act</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-17.pdf">CA-17</a> - Duty Status Report<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/regs/compliance/ca-17_ES.pdf">Informe de estado de servicio</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-20.pdf">CA-20</a> - Attending Physician's Report<ul><li><strong>en español</strong>: <a href="/sites/dolgov/files/OWCP/regs/compliance/ca-20_ES.pdf">Informe del médico tratante</a></li></ul></li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-35.pdf">CA-35</a> - Evidence Required in Support of a Claim for Occupational Disease</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-40.pdf">CA-40</a> - Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-41.pdf">CA-41</a> - Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/CA-42.pdf">CA-42</a> - Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-278.pdf">CA-278</a> - Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-721.pdf">CA-721</a> - Notice of Law Enforcement Officer's Injury Or Occupational Disease</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-722.pdf">CA-722</a> - Notice of Law Enforcement Officer's Death</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1031.pdf">CA-1031</a> - Letter to Dependants to Verify Claimant Support</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1074.pdf">CA-1074</a> - Letter to Parents in Death Claim Development</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1108.pdf">CA-1108</a> - Statement of Recovery Letter with Long Form</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1122.pdf">CA-1122</a> - Statement of Recovery Letter with Short Form</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2231.pdf">CA-2231</a> - Claim for Reimbursement Assisted Reemployment</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-1.pdf">LS-1</a> - Request for Examination and/or Treatment</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-4.pdf">LS-4</a> - Attorney Fee Approval Request</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-5.pdf">LS-5</a> - Application For Special Relief Fund</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-6.pdf">LS-6</a> - Commutation Application</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-7.pdf">LS-7</a> - Request for Intervention</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-8.pdf">LS-8</a> - Settlement Approval Request Section 8(i)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-9.pdf">LS-9</a> - Stipulation Approval Request</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-18.pdf">LS-18</a> - Pre-Hearing Statement</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-33.pdf">LS-33</a> - Approval of Compromise of Third Person Cause of Action</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-200.pdf">LS-200</a> - Report of Earnings</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-201.pdf">LS-201</a> - Notice of Employee's Injury or Death</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-202.pdf">LS-202</a> - Employer's First Report of Injury or Occupational Illness</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-203.pdf">LS-203</a> - Employee's Claim for Compensation</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-204.pdf">LS-204</a> - Attending Physician's Supplementary Report</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-206.pdf">LS-206</a> - Payment of Compensation Without Award</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-207.pdf">LS-207</a> - Notice of Controversion of Right to Compensation</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-208.pdf">LS-208</a> - Notice of Final Payment or Suspension of Compensation Payments</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-210.pdf">LS-210</a> - Employer's Supplementary Report of Accident or Occupational Illness</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-262.pdf">LS-262</a> - Claim for Death Benefits</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-265.pdf">LS-265</a> - Certification of Funeral Expenses</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-266.pdf">LS-266</a> - Application for Continuation of Death Benefit for Student</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-267.pdf">LS-267</a> - Claimant's Statement</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-271.pdf">LS-271</a> - Application for Self-Insurance instructions</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-272.pdf">LS-272</a> - Application to write Longshore Insurance (Carriers)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-274.pdf">LS-274</a> - Report of Injury Experience of Insurance Carrier or Self-Insured Employer</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-275ic.pdf">LS-275ic</a> - Agreement and Undertaking (Insurance Carrier)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-275si.pdf">LS-275si</a> - Agreement and Undertaking (Self-Insured Employer)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-276.pdf">LS-276</a> - Application for Security Deposit Determination. State Guarantee Fund Longshore Security Factor Chart</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-426.pdf">LS-426</a> - Request for Earnings Information</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-513.pdf">LS-513</a> - Report of Payments.</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-570.pdf">LS-570</a> - Carrier's Report of Issuance of Policy (formerly Card Report of Insurance)</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-801.pdf">LS-801</a> - Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers</li><li><a href="https://www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-802.pdf">LS-802</a> - Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion16"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a16"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Veterans' Employment & Training Service</div> </button> </span> <div id="a16" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/agencies/vets/programs/vets4212">VETS-4212</a> - Federal Contractor Reporting - Veteran Hiring</li></ul></div> </div> </div> </div> </div> <div> <div class="paragraph paragraph--type--accordion-item paragraph--view-mode--default dol-accordion dol-accordion-border" role="tablist" aria-multiselectable="true"> <div class="usa-accordion card" id="accordion17"> <span class="mb-0 usa-accordion__heading card"> <button class="usa-accordion__button" aria-controls="a17"> <i class="fa fa-angle-right" aria-hidden="true"></i> <div class="field field--name-field-p-accordion-header field--type-string field--label-hidden clearfix">Wage and Hour Division</div> </button> </span> <div id="a17" class="usa-accordion__content" hidden> <div class="field field--name-field-p-accordion-body field--type-text-long field--label-hidden clearfix"><ul><li><a href="https://www.dol.gov/agencies/whd/contact/complaints">N/A</a> - Wage Complaints</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-2.pdf">WH-2</a> - Application for Special Industrial Homeworker Certificate</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-4.pdf">WH-4</a> - H-1B Nonimmigrant Information</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-5.pdf">WH-5</a> - Certificate of Training Form</li><li><a href="https://www.dol.gov/agencies/whd/government-contracts/construction/surveys/wd10/form">WH-10</a> - DBRA Report of Construction Contractor’s Wage Rates</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-46.pdf">WH-46</a> - Application for Certificateto Employ Homeworkers</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH75EN.pdf">WH-75</a> - Homeworker Handbook</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH75SP.pdf">WH-75</a> - Homeworker Handbook (Spanish)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-200.pdf">WH-200</a> - Application for Authority to Employ Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture Under Regulations 29 C.F.R. Part 519</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-201.pdf">WH-201</a> - Higher Education to Employ its Full-time Students at Subminimum Wages Under Regulations 29 C.F.R. Part 519</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-202.pdf">WH-202</a> - Application for Authority to Employ Six or Fewer Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture Under Regulations 29 C.F.R. Part 519</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-205.pdf">WH-205</a> - Application to Employ Student-Learners at Subminimum Wages</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226.pdf">WH-226 </a>- Application for Authority to Employ Workers with Disabilities at Subminimum Wages</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh226a.pdf">WH-226A</a> - Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Subminimum Wages</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh347.pdf">WH-347</a> - DBRA Certified Payroll Form</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-E.pdf">WH-380-E</a> - FMLA Certification of Health Care Providerfor Employee’s Serious Health Condition</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-380-F.pdf">WH-380-F</a> - FMLA Certification of Health Care Providerfor Family Member’s Serious Health Condition</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-381.pdf">WH-381</a> - FMLA Notice of Eligibility and Rights & Responsibilities</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-382.pdf">WH-382 </a>- FMLA Designation Notice</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-384.pdf">WH-384</a> - FMLA Certification of Qualifying Exigency For Military Family Leave</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-385.pdf">WH-385</a> - FMLA Certification for Serious Injury orIllness of Covered Servicemember -- for Military Family Leave</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH385V.pdf">WH-385V</a> - FMLA Certification for Serious Injury or Illness of a Veteran for Wage and Hour Division Military Caregiver Leave</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/Form_WH-501.PDF">WH-501</a> - MSPA Wage Statement</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/Form_WH-501S.PDF">WH-501</a> - MSPA Wage Statement (Spanish)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh514.pdf">WH-514</a> - MSPA Vehicle Mechanical Inspection Report for Transportation Subjectto Department of Transportation Requirements</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh515.pdf">WH-515</a> - MSPA Doctor’s Certificate</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh516.pdf">WH-516</a> - MSPA Worker Information – Terms of Employment</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH516HaitianCreole.pdf">WH-516</a> - MSPA Worker Information – Terms of Employment (Haitian Creole)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH-516_Spanish.PDF">WH-516</a> - MSPA Worker Information – Terms of Employment (Spanish)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh520.pdf">WH-520</a> - MSPA Housing Occupancy Certificate</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/wh521.pdf">WH-521</a> - MSPA Housing Terms and Conditions</li><li><a href="/sites/dolgov/files/WHD/mspa/wh530.pdf">WH-530</a> - MSPA Application for a Farm Labor Contractor or Farm Labor ContractorEmployee Certificate of Registration</li><li><a href="/sites/dolgov/files/WHD/mspa/wh-530_sp.pdf">WH-530</a> - MSPA Application for a Farm Labor Contractor or Farm Labor ContractorEmployee Certificate of Registration (Spanish)</li><li><a href="https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/WH1481.pdf">WH-1481</a> - EPPA Notice to Examinee</li></ul></div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </article> </div> </div> </div> </main> <footer class="-footer usa-footer usa-footer--big" role="contentinfo"> 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