Employee Benefits Security Administration

U.S.

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

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

Forms & Documents

Browse all Employee Benefits Security Administration government forms

121 - 140 of 158 forms

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

Contact Information & Office Locations

61 - 64 of 64 contact points

Washington DC - Matthew Gisler - Acting

Address:
1335 East-West Hwy
Suite 200
Silver Spring, MD 20910

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

West Virginia

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

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

Wisconsin

Address:
Chicago Regional Office
John C. Kluczynski Federal Bldg
230 S. Dearborn Street
Ste 2160
Chicago, IL 60604

Phone numbers:
  • (312) 353-0900
Fax numbers:
  • (312) 353-1023

Wyoming

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

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

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