U.S. Department of Labor DOL CA EEO LS LM & MSHA Forms in Word

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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-20, Attending Physician's Report

DFEC CA-2a, Notice of Recurrence

DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children

CA-6

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-17, Duty Status Report

DFEC CA-278, Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act

Complaint of Discrimination in Employment Under Federal Government Contracts

Monthly Employment Utilization Report

Monthly Employment Utilization Report

CM-1093, Affidavit of Deceased Miner's Condition

CM-1159, Report of Arterial Blood Gas Study

CM-2907, Report of Ventilatory Study

CM-2970, Operator Response to Schedule for Submission of Additional Evidence

CM-2970a, Operator Response to Notice of Claim

CM-623, Representative Payee Report

CM-623S, Representative Payee Report

CM-787, Physician's/Medical Officer's Statement

CM-893, Certificate of Medical Necessity

CM-908, Notice of Termination, Suspension, Reduction or Increase in Benefit Payments

CM-910, Request To Be Selected As Payee

CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act

CM-911a, Employment History

CM-912, Survivor's Form For Benefits Under The Black Lung Benefits Act

CM-913, Description Of Coal Mine Work and Other Employment

CM-918, Coal Mine Employment Affidavit

CM-929, Report of Changes That May Affect Your Black Lung Benefits

CM-933, Roentgenographic Interpretation

CM-933b, Roentgenographic Quality Rereading

CM-936, Authorization For Release Of Medical Information (Black Lung Benefits)

Authorization For Release of Medical Information (Black Lung Benefits (Black Lung Benefits)

The claimant completes the CM 957 to verify out of pocket medical travel expenses and to request reimbursement for these expenses. The information also ensures that the travel expenses are related to the miner’s black lung condition.

CM-970, Operator Controversion

CM-970a, Operator Response

CM-972, Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The of Labor

CM-981, Certification by School Official

CM-988, Medical History and Examination for Coal Mine Workers' Pneumoconiosis

APPLICANT BACKGROUND QUESTIONNAIRE - DOLRNO1 form

EEOICP EE-1, Claim for Benefits under Energy Employees Occupational Illness Compensation Program Act

The Nursing Relief for Disadvantaged Areas Act of 1999 (NRDAA)

Application for Alien Employment Certification (Part A) (Note: Form ETA-750A is two-sided and must be submitted two-sided.)

Application for Alien Employment Certification (Part B)

ETA-9035 H-1B Specialty (Professional) Workers

Form LM-1 Labor Organization Information Report

Form LM-2 Labor Organization Annual Report

Form LM-10 Employer Report

Form LM-15 Trusteeship Report

Form LM-15A Report on Selection of Delegates and Officers

Form LM-16 Terminal Trusteehip Report

Form LM-20 Agreement and Activities Report (Consultant)

Form LM-21 Receipts and Disbursements Report (Consultant)

Form LM-30 Labor Organization Officer and Employee Report

DLHWC (Longshore) LS-1, Request for Examination and/or Treatment

DLHWC (Longshore) LS-18, Pre-Hearing Statement

DLHWC (Longshore) LS-200, Report of Earnings

DLHWC (Longshore) LS-201, Notice of Employee's Injury or Death

DLHWC (Longshore) LS-202, Employer's First Report of Injury or Occupational Illness

DLHWC (Longshore) LS-203, Employee's Claim for Compensation

DLHWC (Longshore) LS-204, Attending Physician's Supplementary Report

DLHWC (Longshore) LS-205, Physician's Report on Impairment of Vision

DLHWC (Longshore) LS-206, Payment of Compensation Without Award

DLHWC (Longshore) LS-207, Notice of Controversion of Right to Compensation

DLHWC (Longshore) LS-208, Notice of Final Payment or Suspension of Compensation Payments

DLHWC (Longshore) LS-210, Employer's Supplementary Report of Accident or Occupational Illness

DLHWC (Longshore) LS-262, Claim for Death Benefits

DLHWC (Longshore) LS-265, Certification of Funeral Expenses

DLHWC (Longshore) LS-266, Application for Continuation of Death Benefit for Student

DLHWC (Longshore) LS-267, Claimant's Statement

DLHWC (Longshore) LS-271, Application for Self-Insurance

DLHWC (Longshore) LS-274, Report of Injury Experience of Insurance Carrier or of Self-Insured Employer

DOL Form MSHA 7000-2 Quarterly Mine Employment and Coal Production Report

MSNA DOL Form 7000-1 Mine Accident, Injury and Illness Report

Legal Identification Report

OWCP-1

OWCP-915, Miner Medical Reimbursement Form

Health Insurance Claim Form (One of our best sellers!)

S-1 Surety Company Annual Report

UB-92

DOL UB92 Form: Uniform Health Insurance Claim Form

Federal Contractor Veterans' Employment Report

Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference

TApplication for Authority to Employ Workers with Disabilities at Special Minimum Wages

Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages

$17.50

The Certification of Health Care Provider

Employer Response to Employee Request for Family and Medical Leave

H-1B Non-Immigrant Information Form .

The Wage Statement for Migrant and Seasonal Agricultural Workers

Spanish-language version of the Wage Statement for Migrant and Seasonal Agricultural Workers.

The Migrant and Seasonal Agricultural Worker Information Form

Spanish-language version Migrant and Seasonal Agricultural Worker Information Form.