Employee Benefits Security Administration

U.S.

Official Website: https://www.dol.gov/agencies/ebsa

The Employee Benefits Security Administration (EBSA) offers information and assistance on employer-sponsored retirement benefit and health benefit plans.

Forms & Documents

Browse all Employee Benefits Security Administration government forms

41 - 60 of 158 forms

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

Contact Information & Office Locations

41 - 60 of 64 contact points

New York (eastern)

Address:
New York Regional Office
201 Varick Street
Room 746
New York, NY 10014

Phone numbers:
  • (212) 607-8600
Fax numbers:
  • (212) 607-8611

North Carolina

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

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

North Dakota

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

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

Ohio

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

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

Oklahoma

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

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

Oregon

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

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

Pennsylvania

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

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

Puerto Rico

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

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

Rhode Island

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

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

Seattle - Liam Roberts - Supervisor

Address:
300 Fifth Ave

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

South Carolina

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

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

South Dakota

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

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

Tennessee

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

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

Texas

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

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

Utah

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

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

Vermont

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

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

Virginia

Address:
Washington District Office
1335 East-West Hwy
Ste 200
Silver Spring, MD 20910

Phone numbers:
  • (202) 693-8700
Fax numbers:
  • (202) 693-8736

Wake Island

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

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

Washington

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

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

Washington DC

Address:
Washington District Office
1335 East-West Hwy
Ste 200
Silver Spring, MD 20910

Phone numbers:
  • (202) 693-8700
Fax numbers:
  • (202) 693-8736

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