Employee Benefits Security Administration (formerly PWBA) (EBSA)
Employment and Training Administration (ETA)
ESA-Office of Federal Contract Compliance Programs (ESA-OFCCP)
ESA-Office of Labor-Management Standards (ESA-OLMS)
ESA-Office of Workers' Compensation Programs (ESA-OWCP)
- Representative Payee Report
- Representative Payee Report
- Physician’s/Medical Officer’s Statement
- Certificate of Medical Necessity
- Notice of Termination, Suspension, Reduction or Increase in Benefit Payments
- Request to be Selected as Payee
- Miner’s Claim for Benefits Under the Black Lung Benefits Act
- Employment History
- Survivor’s Form for Benefits Under the Black Lung Benefits Act
- Comparability of Current Work to Coal Mine Employment
- Miner Medical Reimbursement Form
- Coal Mine Employment Affidavit
- Instructions for Completion of Form CM-921
- Report of Changes that May Affect Your Black Lung Benefits
- Roentgenographic Interpretation
- Roentgenographic Quality Reading
- Authorization for Release of Medical Information (Black Lung Benefits)
- Medical Travel Refund Request
- Operator Controversion
- Operator Response
- Application for Approval of a Representative’s Fee in a Black Lung Claim Proceeding Conducted by the Department of Labor
- Certification by School Official
- Medical History and Examination for Coal Mine Workers’ Compensation
- Affidavit of Deceased Miner’s Condition
- Report of Arterial Blood Gas Study
- Report of Ventilatory Study
- Operator Response to Schedule for Submission of Additional Evidence
- Operator Response to Notice of Claim
- OWCP-5a, Work Capacity Evaluation For Psychiatric/Psychological Conditions
- OWCP-5b, Work Capacity Evaluation For Cardiovascular/Pulmonary Conditions
- OWCP-5c, Work Capacity Evaluation for Musculoskeletal Conditions
- OWCP-16, Rehabilitation Plan And Award
- OWCP-17, Rehabilitation Maintenance Certificate
- OWCP-44, Rehabilitation Action Report
- OWCP-957, Medical Travel Refund Request
- OWCP-1500, Health Insurance Claim Form
- HCFA-1500, Health Insurance Claim Form
- UB-92, Uniform Health Insurance Claim Form
- OWCP-915, Claim For Medical Reimbursement
- Attending Physician's Supplementary Report
- Claim for Death Benefits
- Employee's Claim for Compensation
- Notice of Employee's Injury or Death
- Reports of Earnings
- Requests for Examination and/or Treatment
- Employer's First Report of Injury or Occupational Illness
- Physicians Report on Impairment of Vision
- Payment of Compensation Without Award
- Notice of Controversion of Right to Compensation
- Pre-Hearing Statement
- Notice of Final Payment or Suspension of Compensation Payments
- Employer's Supplementary Report of Accident or Occupational Illness
- Certification of Funeral Expenses
- Application for Continuation of Death Benefit for Student
- Claimant's Statement
- Application for Self-Insurance
- Report of Injury Experience of Self-Insured Employer
- Authorization For Release of Medical Information (Black Lung Benefits (Black Lung Benefits)
ESA-Office of Workers' Compensation Programs DFEC (ESA-OWCP-DFEC)
- DFEC CA-1, Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
- DFEC CA-2, Notice of Occupational Disease and Claim for Compensation
- DFEC CA-2a, Notice of Recurrence
- DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children
- DFEC CA-5b, Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
- DFEC CA-6, Official Supervisor's Report of Employee's Death
- DFEC CA-7, Claim for Compensation
- DFEC CA-7a, Time Analysis Form
- DFEC CA-7b, Leave Buy Back (LBB) Worksheet/Certification and Election
- DFEC CA-10, What A Federal Employee Should Do When Injured At Work
- DFEC CA-12, Claim For Continuance of Compensation Under the Federal Employees' Compensation Act
- DFEC CA-17, Duty Status Report
- DFEC CA-20, Attending Physician's Report
- DFEC CA-35, Evidence Required in Support of a Claim for Occupational Disease
- DFEC CA-278, Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
- DFEC CA-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease
- DFEC CA-722, Notice of Law Enforcement Officer's Death
- DFEC CA-1031, Letter to Dependants to Verify Claimant Support
- DFEC CA-1074, Letter to Parents in Death Claim Development
- DFEC CA-1108, Statement of Recovery Letter with Long Form
- DFEC CA-1122, Statement of Recovery Letter with Short Form
- DFEC CA-2231, Claim for Reimbursement Assisted Reemployment
ESA-Wage and Hour Division (ESA-WHD)
Mine Health and Safety Administration (MSHA)
Occupational Safety and Health Administration (OSHA)
Office of Assistant Sec. for Administration and Management (OASAM)
Veterans Employment and Training
Service (VETS)
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