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

Form Description Price Buy Now

CA-1 Form

DFEC CA-1, Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation $19.99

CA-2 Form

DFEC CA-2, Notice of Occupational Disease and Claim for Compensation $19.99

CA-2 Form

DFEC CA-20, Attending Physician’s Report $19.99

CA-2a Form

DFEC CA-2a, Notice of Recurrence $19.99

CA-35 (A-H) Form

DFEC CA-35, Evidence Required in Support of a Claim for Occupational Disease (17 pages) $19.99

CA-5 Form

DFEC CA-5, Claim for Compensation by Widow, Widower, and/or Children $19.99

CA 5a Form

DFEC CA-5b, Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren $19.99

CA-6 Form

DFEC CA-6, Official Supervisor’s Report of Employee’s Death $19.99

CA-7 Form

DFEC CA-7, Claim for Compensation $19.99

CA-7A Form

DFEC CA-7a, Time Analysis Form $19.99

CA-7b Form

DFEC CA-7b, Leave Buy Back (LBB) Worksheet/Certification and Election $19.99

CA 10 Form

DFEC CA-10, What A Federal Employee Should Do When Injured At Work $19.99

CA 12 Form

DFEC CA-12, Claim For Continuance of Compensation Under the Federal Employees’ Compensation Act $19.99

CA-17 Form

DFEC CA-17, Duty Status Report $19.99

CA 278 Form

DFEC CA-278, Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act $19.99

CA 721 Form

DFEC CA-721, Notice of Law Enforcement Officer’s Injury Or Occupational Disease $19.99

CA722 Form

DFEC CA-722, Notice of Law Enforcement Officer’s Death $19.99

CA 1031 Form

DFEC CA-1031, Letter to Dependants to Verify Claimant Support $19.99

CA 1074 Form

DFEC CA-1074, Letter to Parents in Death Claim Development $19.99

CA 1108 Form

DFEC CA-1108, Statement of Recovery Letter with Long Form $19.99

CA 1122 Form

DFEC CA-1122, Statement of Recovery Letter with Short Form $19.99

CA 2231 Form

DFEC CA-2231, Claim for Reimbursement Assisted Reemployment $19.99

CC-4 Form

Complaint of Discrimination in Employment Under Federal Government Contracts $40

CC-257 Form in WORD

Monthly Employment Utilization Report $19.99

CC-257 Form in EXCEL

Monthly Employment Utilization Report $19.50

CM-1093 Form

CM-1093, Affidavit of Deceased Miner’s Condition $19.99

CM-1159 Form

CM-1159, Report of Arterial Blood Gas Study $19.99

CM-2907 Form

CM-2907, Report of Ventilatory Study $19.99

CM-2970 Form

CM-2970, Operator Response to Schedule for Submission of Additional Evidence $19.99

CM-2970a Form

CM-2970a, Operator Response to Notice of Claim $19.99

CM-623 Form

CM-623, Representative Payee Report $19.99

CM-623S Form

CM-623S, Representative Payee Report $19.99

CM-787 Form

CM-787, Physician’s/Medical Officer’s Statement $19.99

CM-893 Form

CM-893, Certificate of Medical Necessity $19.99

CM-908 Form

CM-908, Notice of Termination, Suspension, Reduction or Increase in Benefit Payments $19.99

CM-910 Form

CM-910, Request To Be Selected As Payee $19.99

CM-911 Form

CM-911, Miner’s Claim For Benefits Under The Black Lung Benefits Act $40

CM-911a Form

CM-911a, Employment History $19.99

CM-912 Form

CM-912, Survivor’s Form For Benefits Under The Black Lung Benefits Act $19.99

CM-913 Form

CM-913, Description Of Coal Mine Work and Other Employment $40

CM-918 Form

CM-918, Coal Mine Employment Affidavit $19.99

CM-929 Form

CM-929, Report of Changes That May Affect Your Black Lung Benefits $19.99

CM-933 Form

CM-933, Roentgenographic Interpretation $19.99

CM-933b Form

CM-933b, Roentgenographic Quality Rereading $19.99

CM-936 Form

CM-936, Authorization For Release Of Medical In Formation (Black Lung Benefits) $19.99

CM-936 Form

Authorization For Release of Medical In Formation (Black Lung Benefits (Black Lung Benefits) $19.99

CM-957 Form

The claimant completes the CM 957 to verify out of pocket medical travel expenses and to request reimbursement for these expenses. The in Formation also ensures that the travel expenses are related to the miner’s black lung condition. $19.99

CM-970 Form

CM-970, Operator Controversion $19.99

CM-970a Form

CM-970a, Operator Response $19.99

CM-972 Form

CM-972, Application for Approval of a Representative’s Fee in a Black Lung Claim Proceeding Conducted by The of Labor $19.99

CM-981 Form

CM-981, Certification by School Official $19.99

CM-988 Form

CM-988, Medical History and Examination for Coal Mine Workers’ Pneumoconiosis $40

DOL RNO-1 Form


EEO-1 Form

Equal Employment Opportunity Form 1 Form $7.99


EEOICP EE-1, Claim for Benefits under Energy Employees Occupational Illness Compensation Program Act $19.99


EEOICP EE-2, Claim for Survivor Benefits under Energy Employees Occupational Illness Compensation Program Act $19.99


EEOICP EE-3, Employment History for Claim Under Energy Employees Occupational Illness Compensation Program Act $19.99


EEOICP EE-4, Employment History Affidavit for Claim Under Energy Employees Occupational Illness Compensation Program Act $19.99


EEOICP EE-7, Medical Requirements under the Energy Employees Occupational Illness Compensation Program Act $19.99

ETA-9081 Form

The Nursing Relief for Disadvantaged Areas Act of 1999 (NRDAA) $19.99

ETA-750A Form

Application for Alien Employment Certification (Part A) (Note: Form ETA-750A is two-sided and must be ted two-sided.) $19.99

ETA-750B Form

Application for Alien Employment Certification (Part B) $19.99

ETA 790

Agricultural and Food Prrocessing Clearance Order -11 pages (3/19 expiration date) $39.00

ETA 9033

Attestation by Employers using Alien Crewmembers for Longshore Activities in U.S. Ports $19.99

ETA 9033-A

Attestation by Employers Using Alien Crewmembers for Longshore Activities At Locations in the State of Alaska $19.99

ETA 9035 Form

ETA-9035 H-1B Specialty (Professional) Workers $19.99

ETA 9035CP Form

Labor Condition Application and Requirements for Employer Using Nonimmigrants on H-1B Visas OMB 1205-0310 $19.99

ETA 9081 Form

H-1C Nurses for Disadvantaged Areas $19.99

ETA 9089

Application for Permanent Employment Certification $25.50

ETA 9127

Foreign Labor Certification Quarterly Activity Report $19.99

ETA 9141

Application for Prevailing Wage Determination $19.99

ETA 9142

Application for Temporary Employment Certification $25.50

ETA 9142 A.1 and A.2

Application for Temporary Employment Certification-Appendix A.1 and A.2 $19.99

ETA 9142 B.1

Application for Temporary Employment Certification-Appendix B.1 $19.99

LM-1 Form

Form LM-1 Labor Organization In Formation Report $89.99

LM 2 Form

Form LM-2 Labor Organization Annual Report $89.99

LM3 Form

Form LM-3 Labor Organization Annual Report $89.99

LM4 Form

Form LM-4 Labor Organization Annual Report $89.99

LM 10 Form

Form LM-10 Employer Report $21.99

LM 15 Form

Form LM-15 Trusteeship Report $40

LM 15A Form

Form LM-15A Report on Selection of Delegates and Officers $19.99

LM-16 Form

Form LM-16 Terminal Trusteehip Report $19.99

LM-20 Form

Form LM-20 Agreement and Activities Report (Consultant) $19.99

LM-21 Form

Form LM-21 Receipts and Disbursements Report (Consultant) $19.99

LM-30 Form

Form LM-30 Labor Organization Officer and Employee Report $19.99

LS-1 Form

DLHWC (Longshore) LS-1, Request for Examination and/or Treatment $19.99

LS-18 Form

DLHWC (Longshore) LS-18, Pre-Hearing Statement $19.99

LS-33 Form

DLHWC (Longshore) LS-33, Approval of Compromise of Third Person Cause of Action $19.99

LS-200 Form

DLHWC (Longshore) LS-200, Report of Earnings $19.99

LS-201 Form

DLHWC (Longshore) LS-201, Notice of Employee’s Injury or Death $19.99

LS-202 Form

DLHWC (Longshore) LS-202, Employer’s First Report of Injury or Occupational Illness $19.99

LS-203 Form

DLHWC (Longshore) LS-203, Employee’s Claim for Compensation $19.99

LS-204 Form

DLHWC (Longshore) LS-204, Attending Physician’s Supplementary Report $19.99

LS-205 Form

DLHWC (Longshore) LS-205, Physician’s Report on Impairment of Vision $19.99

LS-206 Form

DLHWC (Longshore) LS-206, Payment of Compensation Without Award $19.99

LS-207 Form

DLHWC (Longshore) LS-207, Notice of Controversion of Right to Compensation $19.99

LS-208 Form

DLHWC (Longshore) LS-208, Notice of Final Payment or Suspension of Compensation Payments $19.99

LS-210 Form

DLHWC (Longshore) LS-210, Employer’s Supplementary Report of Accident or Occupational Illness $19.99

LS-262 Form

DLHWC (Longshore) LS-262, Claim for Death Benefits $19.99

LS-265 Form

DLHWC (Longshore) LS-265, Certification of Funeral Expenses $19.99

LS-266 Form

DLHWC (Longshore) LS-266, Application for Continuation of Death Benefit for Student $19.99

LS-267 Form

DLHWC (Longshore) LS-267, Claimant’s Statement $19.99

LS-271 Form

DLHWC (Longshore) LS-271, Application for Self-Insurance $19.99

LS-274 Form

DLHWC (Longshore) LS-274, Report of Injury Experience of Insurance Carrier or of Self-Insured Employer $19.99

LS-276 Form

DLHWC (Longshore) LS-276, Application for Security Deposit Determination $19.99

LS-426 Form

DLHWC (Longshore) LS-426, Request for Earnings In Formation $19.99

MSHA 1219-0007 Form

DOL Form MSHA 7000-2 Quarterly Mine Employment and Coal Production Report $19.99

MSHA 1219-0007 Form

MSNA DOL Form 7000-1 Mine Accident, Injury and Illness Report $19.99

MSHA 1219-0042 Form

DOL Form 2000-7 Legal Identification (ID) Report MUST BE FILED ONLINE Seethis link for more info.

MSHA 1219-0040 Form

DOL Form 7000-52 Contractor Identification (ID) Request $19.99

MSHA 1219-0042 Form

DOL Form 2000-7 MSHA Notification of Representative of Miners $19.99

MSHA 1219-0007 Form

Quarterly Mine Employment and Coal Production Report $19.99

MSHA 1219-0003 Form

DOL Form 4000-9 Record of Individual Exposure to Radon Daughters $19.99

MSHA 1219-0001 Form

DOL Form 5000-1 Certificate of Electrical/Noise Training $19.99

MSHA 1219-0078 Form

DOL Form 5000-3 Certification of Physical Qualification for Mine Rescue Work $19.99

MSHA 1219-0070 Form

DOL Form 5000-41 Certificate of Training $19.99

MSHA 1219-0127 Form

Health Activity Certification or Hoisting Engineers Qualification Request Form $19.99

MSHA 2000-7 Form

Legal Identification Report $19.99

MSHA 1219-0066 Form

DOL Form 2000-38 Electrically Operated Mining Equipment Field Approval Application (Coal Operator) $19.99

OWCP1 Form

OWCP-1 Agreement and Undertaking $19.99

OWCP1168 Form

OWCP-1168, Black Lung Provider Enrollment Form $19.99

OWCP957 Form

OWCP-957, Medical Travel Refund Request $19.99

OWCP-915 Form

OWCP-915, Miner Medical Reimbursement Form $19.99

OWCP-1500 Form

Health Insurance Claim Form(One of our best sellers!) $19.99

S1 Form

S-1 Surety Company Annual Report $19.99

T1 Form

Form T-1 Trust Annual Report $19.99


DOL UB92 Form: Uniform Health Insurance Claim Form $19.99

VETS-100 Form

Federal Contractor Veterans’ Employment Report $19.99

VETS-1010 Form

Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans’ Preference $19.99

WH-226 Form

TApplication for Authority to Employ Workers with Disabilities at Special Minimum Wages $19.99

WH-226A Form

Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages $19.99

WH-348 Form

Certified Payroll Form-Additional Form included in our WH347 package;Click here to see Certified Payroll order Page $19.99 See our CPR Page.

WH-347 in Excel

Federal Form (U.S. Dept. of Labor) US DOL WH347 & WH348 in Excel & Word (see PDF here)(OUR BEST SELLER!)Click here to see instructions by DOL. $19.99

WH-347 in Word

Certified Payroll Form in Word-WH 347& WH348 in Word only $19.99

WH-380 Form

The Certification of Health Care Provider $40.00

WH-381 Form

Employer Response to Employee Request for Family and Medical Leave $19.99

WH-382 (New!) Form

Designation Notice (Family and Medical Leave Act) Form $19.99

WH-4 Form

H-1B Non-Immigrant In Formation Form $19.99

WH-501 Forms in Word

The Wage Statement for Migrant and Seasonal Agricultural Workers IN WORD $19.99

WH-501 Form IN EXCEL

The Wage Statement for Migrant and Seasonal
Agricultural Workers IN EXCEL

WH-501S Form

Spanish-language version of the Wage Statement for Migrant and Seasonal Agricultural Workers. $19.99

WH-516 English Form

The Migrant and Seasonal Agricultural Worker In Formation Form $19.99

WH-516 Spanish

Spanish-language version Migrant and Seasonal Agricultural Worker In Formation Form. $19.99