Forms

These are the most frequently requested Department of Labor forms. You can complete some forms online, while you can download and print all others.

Expand All
  • 2000-7 (Form Name - Legal Identification Report; Agency - Mine Safety and Health Administration)
  • 2000-38 (Form Name - Electrically Operated Equipment Field Approval Application (Coal Only); Agency - Mine Safety and Health Administration)
  • 2000-222 (Form Name - Self Contained Self Rescuer (SCSR) Inventory and Report; Agency - Mine Safety and Health Administration)
  • 2000-224 (Form Name - Operator’s Annual Certification of Mine Rescue Teams Qualifications; Agency - Mine Safety and Health Administration)
  • 2000-238 (Form Name - Representative of Miners Designation Form; Agency - Mine Safety and Health Administration)
  • 4000-9 (Form Name - Record of Individual Exposure to Radon Daughters; Agency - Mine Safety and Health Administration)
  • 5000-1 (Form Name - Certificate of Electrical/Noise Training; Agency - Mine Safety and Health Administration)
  • 5000-3 (Form Name - Certificate of Physical Qualification for Mine Rescue Work; Agency - Mine Safety and Health Administration)
  • 5000-23 (Form Name - Certificate of Training; Agency - Mine Safety and Health Administration)
  • 5000-41 (Form Name - Health Activity Certification or Hoisting Engineers Qualification Request; Agency - Mine Safety and Health Administration)
  • 5000-46 (Form Name - Request an MSHA Individual Identification Number (MIIN); Agency - Mine Safety and Health Administration)
  • 5500 (Form Name - 5500 Series; Agency - Employee Benefits Security Administration)
  • 7000-1 (Form Name - Mine Accident, Injury and Illness Report; Agency - Mine Safety and Health Administration)
  • 7000-2 (Form Name - Quarterly Mine Employment and Coal Production Report; Agency - Mine Safety and Health Administration)
  • 7000-51 (Form Name - Mine ID Request; Agency - Mine Safety and Health Administration)
  • 7000-52 (Form Name - Contractor ID Request; Agency - Mine Safety and Health Administration)
  • AB-1 (Form Name - Appeal Form; Agency - Employees' Compensation Appeals Board)
  • CA-1 (Form Name - Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-2 (Form Name - Notice of Occupational Disease and Claim for Compensation; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-2a (Form Name - Notice of Recurrence; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-5 (Form Name - Claim for Compensation by Widow, Widower, and/or Children; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-5b (Form Name - Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-6 (Form Name - Official Supervisor's Report of Employee's Death; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-7 (Form Name - Claim for Compensation; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-7a (Form Name - Time Analysis Form, used for claiming compensation, including repurchase of paid leave; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-7b (Form Name - Leave Buy Back (LBB) Worksheet/Certification and Election; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-10 (Form Name - What A Federal Employee Should Do When Injured At Work; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-12 (Form Name - Claim For Continuance of Compensation Under the Federal Employees' Compensation Act; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-17 (Form Name - Duty Status Report; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-20 (Form Name - Attending Physician's Report; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-35 (Form Name - Evidence Required in Support of a Claim for Occupational Disease; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-40 (Form Name - Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-41 (Form Name - Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-42 (Form Name - Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-278 (Form Name - Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-721 (Form Name - Notice of Law Enforcement Officer's Injury Or Occupational Disease; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-722 (Form Name - Notice of Law Enforcement Officer's Death; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-1031 (Form Name - Letter to Dependants to Verify Claimant Support; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-1074 (Form Name - Letter to Parents in Death Claim Development; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-1108 (Form Name - Statement of Recovery Letter with Long Form; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-1122 (Form Name - Statement of Recovery Letter with Short Form; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CA-2231 (Form Name - Claim for Reimbursement Assisted Reemployment; Agency - Office of Workers' Compensation Programs - Division of Federal Employees' Compensation)
  • CM-623 (Form Name - Representative Payee Report; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-787 (Form Name - Physician's/Medical Officer's Statement; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-893 (Form Name - Certificate of Medical Necessity; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-908 (Form Name - Notice of Termination, Suspension, Reduction or Increase in Benefit Payments; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-910 (Form Name - Request To Be Selected As Payee; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-911 (Form Name - Miner's Claim For Benefits Under The Black Lung Benefits Act; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-911a (Form Name - Employment History; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-912 (Form Name - Survivor's Form For Benefits Under The Black Lung Benefits Act; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-913 (Form Name - Description Of Coal Mine Work and Other Employment; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-921 (Form Name - Instructions For Completion of Form CM-921; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-929 (Form Name - Report of Changes That May Affect Your Black Lung Benefits; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-929P (Form Name - Report of Changes That May Affect Your Black Lung Benefits; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-933 (Form Name - Roentgenographic Interpretation; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-933b (Form Name - Roentgenographic Quality Rereading; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-936 (Form Name - Authorization For Release Of Medical Information (Black Lung Benefits); Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-972 (Form Name - Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-981 (Form Name - Certification by School Official; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-988 (Form Name - Medical History and Examination for Coal Mine Workers' Pneumoconiosis; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-1159 (Form Name - Report of Arterial Blood Gas Study; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-2907 (Form Name - Report of Ventilatory Study; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-2970 (Form Name - Operator Response to Schedule for Submission of Additional Evidence; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-2970a (Form Name - Operator Response to Notice of Claim; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • CM-623S (Form Name - Representative Payee Report; Agency - Office of Workers' Compensation Programs - Division of Coal Mine Workers' Compensation)
  • EE-1 (Form Name - Employee's Claim; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)
  • EE-2 (Form Name - Survivor's Claim; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)
  • EE-3 (Form Name - Employment History; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)
  • EE-4 (Form Name - Employment History Affidavit; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)
  • EE-7 (Form Name - Medical Requirements; Agency - Office of Workers' Compensation Programs - Division of Energy Employees Occupational Illness Compensation)
  • LM-1 (Form Name - Labor Organization Information Report; Agency - Office of Labor-Management Standards)
  • LM-2 (Form Name - Labor Organization Annual Report; Agency - Office of Labor-Management Standards)
  • LM-3 (Form Name - Labor Organization Annual Report ; Agency - Office of Labor-Management Standards)
  • LM-4 (Form Name - Labor Organization Annual Report ; Agency - Office of Labor-Management Standards)
  • LM-10 (Form Name - Employer Report; Agency - Office of Labor-Management Standards)
  • LM-15 (Form Name - Trusteeship Report; Agency - Office of Labor-Management Standards)
  • LM-15A (Form Name - Report on Selection of Delegates and Officers; Agency - Office of Labor-Management Standards)
  • LM-16 (Form Name - Terminal Trusteeship Report; Agency - Office of Labor-Management Standards)
  • LM-20 (Form Name - Agreement and Activities Report; Agency - Office of Labor-Management Standards)
  • LM-21 (Form Name - Receipts and Disbursements Report; Agency - Office of Labor-Management Standards)
  • LM-30 (Form Name - Labor Organization Officer and Employee Report; Agency - Office of Labor-Management Standards)
  • LS-1 (Form Name - Request for Examination and/or Treatment; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-18 (Form Name - Pre-Hearing Statement; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-33 (Form Name - Approval of Compromise of Third Person Cause of Action; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-200 (Form Name - Report of Earnings; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-201 (Form Name - Notice of Employee's Injury or Death; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-202 (Form Name - Employer's First Report of Injury or Occupational Illness; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-203 (Form Name - Employee's Claim for Compensation; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-204 (Form Name - Attending Physician's Supplementary Report; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-206 (Form Name - Payment of Compensation Without Award; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-207 (Form Name - Notice of Controversion of Right to Compensation; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-208 (Form Name - Notice of Final Payment or Suspension of Compensation Payments; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-210 (Form Name - Employer's Supplementary Report of Accident or Occupational Illness; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-262 (Form Name - Claim for Death Benefits; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-265 (Form Name - Certification of Funeral Expenses; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-266 (Form Name - Application for Continuation of Death Benefit for Student; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-267 (Form Name - Claimant's Statement; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-271 (Form Name - Application for Self-Insurance instructions; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-272 (Form Name - Application to write Longshore Insurance (Carriers); Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-274 (Form Name - Report of Injury Experience of Insurance Carrier or Self-Insured Employer; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-275ic (Form Name - Agreement and Undertaking (Insurance Carrier); Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-275si (Form Name - Agreement and Undertaking (Self-Insured Employer); Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-276 (Form Name - Application for Security Deposit Determination. State Guarantee Fund Longshore Security Factor Chart; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-426 (Form Name - Request for Earnings Information; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-513 (Form Name - Report of Payments.; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-570 (Form Name - Carrier's Report of Issuance of Policy (formerly Card Report of Insurance); Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-801  (Form Name - Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • LS-802  (Form Name - Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives; Agency - Office of Workers' Compensation Programs - Division of Longshore and Harbor Workers' Compensation)
  • M-1 (Form Name - Multiple Employer Welfare Arrangements (MEWAs) Annual Report; Agency - Employee Benefits Security Administration)
  • OWCP-04 (Form Name - Uniform Billing Form; Agency - Office of Workers' Compensation Programs)
  • OWCP-5a (Form Name - Work Capacity Evaluation Psychiatric/Psychological Conditions; Agency - Office of Workers' Compensation Programs)
  • OWCP-5b (Form Name - Work Capacity Evaluation Cardiovascular/Pulmonary Conditions; Agency - Office of Workers' Compensation Programs)
  • OWCP-5c (Form Name - Work Capacity Evaluation for Musculoskeletal Conditions; Agency - Office of Workers' Compensation Programs)
  • OWCP-16 (Form Name - Rehabilitation Plan And Award; Agency - Office of Workers' Compensation Programs)
  • OWCP-17 (Form Name - Rehabilitation Maintenance Certificate; Agency - Office of Workers' Compensation Programs)
  • OWCP-20 (Form Name - Overpayment Recovery Questionnaire; Agency - Office of Workers' Compensation Programs)
  • OWCP-44 (Form Name - Rehabilitation Action Report; Agency - Office of Workers' Compensation Programs)
  • OWCP-915 (Form Name - Claim For Medical Reimbursement; Agency - Office of Workers' Compensation Programs)
  • OWCP-957 (Form Name - Medical Travel Refund Request; Agency - Office of Workers' Compensation Programs)
  • OWCP-1168 (Form Name - Provider Enrollment form; Agency - Office of Workers' Compensation Programs)
  • OWCP-1500 (Form Name - Health Insurance Claim Form; Agency - Office of Workers' Compensation Programs)
  • S-1 (Form Name - Surety Company Annual Report; Agency - Office of Labor-Management Standards)
  • VETS-4212 (Form Name - Federal Contractor Reporting - Veteran Hiring; Agency - Veterans' Employment & Training Service)
  • N/A (Form Name - Administrative Subpoena to Appear & Testify at a Deposition; Agency - Office of Administrative Law Judges)
  • N/A (Form Name - Administrative Subpoena to Appear & Testify at a Hearing; Agency - Office of Administrative Law Judges)
  • N/A (Form Name - Administrative Subpoena to Produce Documents, Information or Objects, or to Permit Inspection of Premises; Agency - Office of Administrative Law Judges)
  • N/A (Form Name - Black Lung Benefits Act Evidence Summary Form; Agency - Office of Administrative Law Judges)
  • N/A (Form Name - Certificates of Achievement in Safety; Agency - Mine Safety and Health Administration)
  • N/A (Form Name - Electronic Training Plan Advisor; Agency - Mine Safety and Health Administration)
  • N/A (Form Name - Federal Contractor Discrimination Complaint; Agency - Office of Federal Contract Compliance Programs)
  • N/A (Form Name - Hazardous Condition Complaint; Agency - Mine Safety and Health Administration)
  • N/A (Form Name - Inspector General Hotline; Agency - Office of Inspector General)
  • N/A (Form Name - LHWCA Prehearing Statement Form; Agency - Office of Administrative Law Judges)
  • N/A (Form Name - LHWCA Uniform Stipulations Form; Agency - Office of Administrative Law Judges)
  • N/A (Form Name - Manage/Update Diesel Inventory; Agency - Mine Safety and Health Administration)
  • N/A (Form Name - Report Commencement/Closure of Operation – Metal and Nonmetal Mines; Agency - Mine Safety and Health Administration)
  • N/A (Form Name - Safety and Health Complaint; Agency - Occupational Safety and Health Administration)
  • N/A (Form Name - Settlement Judge Request; Agency - Office of Administrative Law Judges)
  • N/A (Form Name - Wage Complaints; Agency - Wage and Hour Division)
Forms By Agency
Expand All
  • 5500 - 5500 Series
  • M-1 - Multiple Employer Welfare Arrangements (MEWAs) Annual Report
  • 2000-7 - Legal Identification Report
  • 2000-38 - Electrically Operated Equipment Field Approval Application (Coal Only)
  • 2000-222 - Self Contained Self Rescuer (SCSR) Inventory and Report
  • 2000-224 - Operator’s Annual Certification of Mine Rescue Teams Qualifications
  • 2000-238 - Representative of Miners Designation Form
  • 4000-9 - Record of Individual Exposure to Radon Daughters
  • 5000-1 - Certificate of Electrical/Noise Training
  • 5000-3 - Certificate of Physical Qualification for Mine Rescue Work
  • 5000-23 - Certificate of Training
  • 5000-41 - Health Activity Certification or Hoisting Engineers Qualification Request
  • 5000-46 - Request an MSHA Individual Identification Number (MIIN)
  • 7000-1 - Mine Accident, Injury and Illness Report
  • 7000-2 - Quarterly Mine Employment and Coal Production Report
  • 7000-51 - Mine ID Request
  • 7000-52 - Contractor ID Request
  • N/A - Certificates of Achievement in Safety
  • N/A - Electronic Training Plan Advisor
  • N/A - Hazardous Condition Complaint
  • N/A - Manage/Update Diesel Inventory
  • N/A - Report Commencement/Closure of Operation – Metal and Nonmetal Mines
  • N/A - Administrative Subpoena to Appear & Testify at a Deposition
  • N/A - Administrative Subpoena to Appear & Testify at a Hearing
  • N/A - Administrative Subpoena to Produce Documents, Information or Objects, or to Permit Inspection of Premises
  • N/A - Black Lung Benefits Act Evidence Summary Form
  • N/A - LHWCA Prehearing Statement Form
  • N/A - LHWCA Uniform Stipulations Form
  • N/A - Settlement Judge Request
  • N/A - Federal Contractor Discrimination Complaint
  • N/A - Inspector General Hotline
  • LM-1 - Labor Organization Information Report
  • LM-2 - Labor Organization Annual Report
  • LM-3 - Labor Organization Annual Report
  • LM-4 - Labor Organization Annual Report
  • LM-10 - Employer Report
  • LM-15 - Trusteeship Report
  • LM-15A - Report on Selection of Delegates and Officers
  • LM-16 - Terminal Trusteeship Report
  • LM-20 - Agreement and Activities Report
  • LM-21 - Receipts and Disbursements Report
  • LM-30 - Labor Organization Officer and Employee Report
  • S-1 - Surety Company Annual Report
  • OWCP-04 - Uniform Billing Form
  • OWCP-5a - Work Capacity Evaluation Psychiatric/Psychological Conditions
  • OWCP-5b - Work Capacity Evaluation Cardiovascular/Pulmonary Conditions
  • OWCP-5c - Work Capacity Evaluation for Musculoskeletal Conditions
  • OWCP-16 - Rehabilitation Plan And Award
  • OWCP-17 - Rehabilitation Maintenance Certificate
  • OWCP-20 - Overpayment Recovery Questionnaire
  • OWCP-44 - Rehabilitation Action Report
  • OWCP-915 - Claim For Medical Reimbursement
  • OWCP-957 - Medical Travel Refund Request
  • OWCP-1168 - Provider Enrollment form
  • OWCP-1500 - Health Insurance Claim Form
  • CM-623 - 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-921 - Instructions For Completion of Form CM-921
  • CM-929 - Report of Changes That May Affect Your Black Lung Benefits
  • CM-929P - 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)
  • CM-972 - Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by The U.S. Department of Labor
  • CM-981 - Certification by School Official
  • CM-988 - Medical History and Examination for Coal Mine Workers' Pneumoconiosis
  • 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-623S - Representative Payee Report
  • EE-1 - Employee's Claim
  • EE-2 - Survivor's Claim
  • EE-3 - Employment History
  • EE-4 - Employment History Affidavit
  • EE-7 - Medical Requirements
  • CA-1 - Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
  • CA-2 - Notice of Occupational Disease and Claim for Compensation
  • CA-2a - Notice of Recurrence
  • CA-5 - Claim for Compensation by Widow, Widower, and/or Children
  • CA-5b - Claim for Compensation by Parents, Brothers, Sisiters, GrandParents, or GrandChildren
  • CA-6 - Official Supervisor's Report of Employee's Death
  • CA-7 - Claim for Compensation
  • CA-7a - Time Analysis Form, used for claiming compensation, including repurchase of paid leave
  • CA-7b - Leave Buy Back (LBB) Worksheet/Certification and Election
  • CA-10 - What A Federal Employee Should Do When Injured At Work
  • CA-12 - Claim For Continuance of Compensation Under the Federal Employees' Compensation Act
  • CA-17 - Duty Status Report
  • CA-20 - Attending Physician's Report
  • CA-35 - Evidence Required in Support of a Claim for Occupational Disease
  • CA-40 - Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under 5 U.S.C. § 8102a
  • CA-41 - Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity
  • CA-42 - Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity
  • CA-278 - Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act
  • CA-721 - Notice of Law Enforcement Officer's Injury Or Occupational Disease
  • CA-722 - Notice of Law Enforcement Officer's Death
  • CA-1031 - Letter to Dependants to Verify Claimant Support
  • CA-1074 - Letter to Parents in Death Claim Development
  • CA-1108 - Statement of Recovery Letter with Long Form
  • CA-1122 - Statement of Recovery Letter with Short Form
  • CA-2231 - Claim for Reimbursement Assisted Reemployment
  • LS-1 - Request for Examination and/or Treatment
  • LS-18 - Pre-Hearing Statement
  • LS-33 - Approval of Compromise of Third Person Cause of Action
  • LS-200 - Report of Earnings
  • LS-201 - Notice of Employee's Injury or Death
  • LS-202 - Employer's First Report of Injury or Occupational Illness
  • LS-203 - Employee's Claim for Compensation
  • LS-204 - Attending Physician's Supplementary Report
  • LS-206 - Payment of Compensation Without Award
  • LS-207 - Notice of Controversion of Right to Compensation
  • LS-208 - Notice of Final Payment or Suspension of Compensation Payments
  • LS-210 - Employer's Supplementary Report of Accident or Occupational Illness
  • LS-241 / LS-242 - Notice to Employees (This form is provided by the Insurance Carrier when the policy is issued. Employers should request from their carrier. Carriers and self-insurers should request from their corporate compliance department.) 
  • LS-262 - Claim for Death Benefits
  • LS-265 - Certification of Funeral Expenses
  • LS-266 - Application for Continuation of Death Benefit for Student
  • LS-267 - Claimant's Statement
  • LS-271 - Application for Self-Insurance instructions
  • LS-272 - Application to write Longshore Insurance (Carriers)
  • LS-274 - Report of Injury Experience of Insurance Carrier or Self-Insured Employer
  • LS-275ic - Agreement and Undertaking (Insurance Carrier)
  • LS-275si - Agreement and Undertaking (Self-Insured Employer)
  • LS-276 - Application for Security Deposit Determination. State Guarantee Fund Longshore Security Factor Chart
  • LS-426 - Request for Earnings Information
  • LS-513 - Report of Payments.
  • LS-570 - Carrier's Report of Issuance of Policy (formerly Card Report of Insurance)
  • LS-801  - Waiver of Service by Registered or Certified Mail for Employers and/or Insurance Carriers
  • LS-802  - Waiver of Service by Registered or Certified Mail for Claimants and Authorized Representatives
  • OWCP-5a - Work Capacity Evaluation (Psychiatric/Psychological Conditions)
  • OWCP-5b - Work Capacity Evaluation (Cardiovascular/Pulmonary Conditions)
  • OWCP-5c - Work Capacity Evaluation (Musculoskeletal Conditions)
  • OWCP-16 - Rehabilitation Plan And Award
  • OWCP-17 - Rehabilitation Maintenance Certificate
  • OWCP-44 - Rehabilitation Action Report
  • VETS-4212 - Federal Contractor Reporting - Veteran Hiring
  • N/A - Wage Complaints