Department of Labor (DOL) Forms

Many DOL forms are housed on its EBSA agency site. Check here for some of the most frequently requested forms. You can complete some forms online, while you can download and print others. Many forms require Adobe Acrobat to download and print.

• For Departments of Labor by State, including State Labor Offices, Commissioners, Directors, and Secretaries, click here.
• For EEOC Forms, click here. [Revised EEO-1].
• For forms from other agencies, try FedForms.gov.

If you cannot find your form below (or if the link is inoperable), click here for the DOL forms library.

A

• Affidavit of Deceased Miner’s Condition
• Annual Return/Report of Employee Benefit Plan
• APPLICANT BACKGROUND QUESTIONNAIRE
• Application for Alien Employment Certification (Part A)
• Application for Alien Employment Certification (Part B)
• Application for Approval of a Representative’s Fee in a Black Lung Claim Proceeding Conducted by the Department of Labor
• Application for Authority to Employ Workers with Disabilities at Special Minimum Wages
• Application for Continuation of Death Benefit for Student
• Application for EFAST Electronic Signature and Codes for EFAST Transmitters and Signature Developers
• Application for Self-Insurance
• Attending Physician's Supplementary Report
• Authorization For Release of Medical Information (Black Lung Benefits (Black Lung Benefits)
• Authorization for Release of Medical Information (Black Lung Benefits)

C

• Certificate of Electrical/Noise Training
• Certificate of Medical Necessity
• Certificate of Training
• Certification by School Official
• Certification of Funeral Expenses
• Certification of Physical Qualification for Mine Rescue Work
• Claim for Death Benefits
• Claimant's Statement
• Coal Mine Employment Affidavit
• Comparability of Current Work to Coal Mine Employment
• Complaint of Discrimination in Employment Under Federal Government Contracts
• Contractor Identification (ID) Request

D

• DFEC CA-1, Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
• DFEC CA-10, What A Federal Employee Should Do When Injured At Work
• 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-12, Claim For Continuance of Compensation Under the Federal Employees' Compensation Act
• DFEC CA-17, Duty Status Report
• DFEC CA-2, Notice of Occupational Disease and Claim for Compensation
• DFEC CA-20, Attending Physician's Report
• DFEC CA-2231, Claim for Reimbursement Assisted Reemployment
• DFEC CA-278, Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
• DFEC CA-2a, Notice of Recurrence
• DFEC CA-35, Evidence Required in Support of a Claim for Occupational Disease
• 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-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease
• DFEC CA-722, Notice of Law Enforcement Officer's Death
• DFEC CA-7a, Time Analysis Form
• DFEC CA-7b, Leave Buy Back (LBB) Worksheet/Certification and Election

E

• Electrically Operated Mining Equipment Field Approval Application (Coal Operator)
• Eligibility Data Form: Uniformed Services Employment and Reemployment Rights Act and Veterans' Preference
• Employee's Claim for Compensation
• Employer's First Report of Injury or Occupational Illness
• Employer's Supplementary Report of Accident or Occupational Illness
• Employment History

F

• Family and Medical Leave Act of 1993 (Certification of Health Care Provider)
• Family and Medical Leave Act of 1993 (Employer Response to Employee Request for Family or Medical Leave)
• Federal Contractor Veterans' Employment Report
• Form LM-1 Labor Organization Information 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-2 Labor Organization Annual Report
• Form LM-20 Agreement and Activities Report (Consultant)
• Form LM-21 Receipts and Disbursements Report (Consultant)
• Form LM-3 Labor Organization Annual Report
• Form LM-30 Labor Organization Officer and Employee Report
• Form LM-4 Labor Organization Annual Report
• Form S-1 Surety Company Annual Report
• Form T-1 Trust Annual Report

H

• H-1B Nonimmigrant Information Form
• H-1B Specialty (Professional) Workers
• H-1C Nurses for Disadvantaged Areas
• HCFA-1500, Health Insurance Claim Form
• Health Activity Certification or Hoisting Engineers Qualification Request Form

I

• Instructions for Completion of Form CM-921

L

• Labor Condition Application and Requirements for Employer Using Nonimmigrants on H-1B Visas
• Legal Identification (ID) Report

M

• Medical History and Examination for Coal Mine Workers’ Compensation
• Medical Travel Refund Request
• Mine Accident, Injury and Illness Report
• Mine Identification (ID) Request
• Miner Medical Reimbursement Form
• Miner’s Claim for Benefits Under the Black Lung Benefits Act
• MSHA Notification of Representative of Miners

N

• Notice of Alleged Safety or Health Hazards
• Notice of Controversion of Right to Compensation
• Notice of Employee's Injury or Death
• Notice of Final Payment or Suspension of Compensation Payments
• Notice of Termination, Suspension, Reduction or Increase in Benefit Payments

O

• Operator Controversion
• Operator Response
• Operator Response to Notice of Claim
• Operator Response to Schedule for Submission of Additional Evidence
• Optional Use Payroll Form Under the Davis-Bacon Act
• OWCP-1500, Health Insurance Claim Form
• OWCP-16, Rehabilitation Plan And Award
• OWCP-17, Rehabilitation Maintenance Certificate
• OWCP-44, Rehabilitation Action Report
• 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-915, Claim For Medical Reimbursement
• OWCP-957, Medical Travel Refund Request

P

• Payment of Compensation Without Award
• Physician’s/Medical Officer’s Statement
• Physicians Report on Impairment of Vision
• Pre-Hearing Statement

Q

• Quarterly Mine Employment and Coal Production Report

R

• Record of Individual Exposure to Radon Daughters
• Report of Arterial Blood Gas Study
• Report of Changes that May Affect Your Black Lung Benefits
• Report of Injury Experience of Self-Insured Employer
• Report of Payments
• Report of Ventilatory Study
• Reports of Earnings
• Representative Payee Report
• Representative Payee Report
• Request to be Selected as Payee
• Requests for Examination and/or Treatment
• Revised Form LM-2 Labor Organization Annual Report
• Roentgenographic Interpretation
• Roentgenographic Quality Reading

S

• Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages
• Survivor’s Form for Benefits Under the Black Lung Benefits Act

U

• UB-92, Uniform Health Insurance Claim Form
• USERRA Poster

W

• Wage Statement
• Wage Statement (In Spanish)
• Worker Information, Terms and Conditions of Employment
• Worker Information, Terms and Conditions of Employment (In Spanish)