| OMB Number | Title |
|---|
| 1215-0209 |
Notification of Employee Rights Under Federal Labor Laws |
| 1215-0208 |
Work-Study Program of the Child Labor Regulations (WSP) Regulations 29 CFR Section 570.35b |
| 1215-0207 |
Carrier's Report of Issuance of Policy |
| 1215-0206 |
Death Gratuity |
| 1215-0205 |
Form LM-30 Labor Organization Officer and Employee Report |
| 1215-0204 |
Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions |
| 1215-0203 |
EO 13201 - Notice of Employee Rights Concerning Payment of Union Dues or Fees |
| 1215-0202 |
Claim for Reimbursement of Benefit Payments and Claims Expense Under the War Hazards Compensation Act |
| 1215-0201 |
The Secretary of Labor's Opportunity Award, Exemplary Voluntary Effort (EVE), and Exemplary Public Interest Contribution (EPIC) Awards |
| 1215-0200 |
Statement of Recovery Forms |
| 1215-0199 |
Alternate Employment Information Request |
| 1215-0197 |
Energy Employees Occupational Illness Compensation Program Act Forms (Various) |
| 1215-0196 |
Equal Opportunity Survey |
| 1215-0195 |
Survey of Physicians Board Certified in Internal Medicine with Facilities |
| 1215-0194 |
Pharmacy Billing Requirements |
| 1215-0193 |
Claim for Medical Reimbursement Form |
| 1215-0192 |
Employment Under Special Certificates of Apprentices, Messengers and Learners (including Student Learners) |
| 1215-0191 |
Airline Vacancy Listing |
| 1215-0190 |
Nondisplacement of Qualified Workers Under Service Contracts |
| 1215-0188 |
Labor Organization and Auxiliary Reports |
| 1215-0187 |
Worker Information - Terms and Conditions of Employment |
| 1215-0184 |
Service Contract Act Occupational Employment Questionnaire |
| 1215-0183 |
PROCEDURES FOR THE HANDLING OF DISCRIMINATION COMPLAINTS UNDER FEDERAL EMPLOYEE PROTECTION STATUTES -- 29 CFR PART 24 |
| 1215-0182 |
Rehabilitation Action Report |
| 1215-0181 |
29 C.F.R. Part 825, The Family and Medical Leave Act of 1993 |
| 1215-0179 |
NOTICE TO BENEFICIARY (RO MONTHLY) NOTICE TO BENEFICIARY (RO MBO) NOTICE TO BENEFICIARY (TF MBO) |
| 1215-0178 |
Claim for Reimbursement-Assisted Reemployment |
| 1215-0177 |
Resubmission Turnaround Document |
| 1215-0176 |
Uniform Billing Form (OWCP-04) |
| 1215-0175 |
Partial Overtime Exemption for Remedial Education |
| 1215-0174 |
PATIENT ADVOCATE PILOT QUESTIONNAIRE - PHYSICIAN INTERVIEW |
| 1215-0173 |
Representative Payee Report, Representative Payee Report, Short Form, Physician's Medical Officer's Statement |
| 1215-0172 |
29 CFR 517 - TRAINING WAGE PROVISIONS OF THE FAIR LABOR STANDARDS AMENDMENTS OF 1989 |
| 1215-0171 |
Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor |
| 1215-0170 |
Application of the Employee Polygraph Protection Act |
| 1215-0169 |
REPORTING AND EMPLOYMENT REQUIREMENTS FOR EMPLOYERS OF CERTAIN WORKERS EMPLOYED IN SEASONAL AGRICULTURAL SERVICES, 29 CFR PART 502 |
| 1215-0168 |
WORK-DAY REPORT |
| 1215-0167 |
Notice of Recurrence |
| 1215-0166 |
Request to be Selected as Payee |
| 1215-0165 |
PERMISSIBLE HOURS OF EMPLOYMENT FOR BAT BOYS AND BAT GIRLS |
| 1215-0163 |
Construction Recordkeeping and Reporting |
| 1215-0162 |
GENERAL REGULATIONS UNDER THE WALSH-HEALEY PUBLIC CONTRACTS ACT, 41 CFR PART 50-201.101(A)(2)(I) AND (II), 50-201.501, 50-201.604(A) AND (C) |
| 1215-0161 |
Rehabilitation Maintenance Certificate |
| 1215-0160 |
Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act |
| 1215-0159 |
NOTICE OF INTENT TO EMPLOY HOMEWORKERS IN A RESTRICTED INDUSTRY |
| 1215-0158 |
Housing Occupancy Certificate--Migrant and Seasonal Agricultural Worker Protection Act |
| 1215-0157 |
GENERAL REGULATIONS UNDER THE WALSH-HEALEY PUBLIC CONTRACTS ACT 41 CFR PART 50-201.101(A)(2)(XI) |
| 1215-0155 |
Claim for Compensation by Dependents Information Reports |
| 1215-0154 |
Claim for Continuance of Compensation |
| 1215-0152 |
SURVEY OF OCCUPATIONAL WAGES AND EMPLOYEE BENEFITS IN THE CONSTRUCTION INDUSTRY, COBB COUNTY, GEORGIA |
| 1215-0151 |
Request for Information on Earnings, Dual Benefits, Dependents and Third Part Settlements |
| 1215-0150 |
Labor Standards for Federal Service Contracts - Regulations 29 CFR, Part 4 |
| 1215-0149 |
Davis-Bacon Certified Payroll |
| 1215-0148 |
Migrant and Seasonal Agricultural Worker Protection Act Wage Statement |
| 1215-0146 |
Housing Terms and Conditions For MSPA Workers |
| 1215-0145 |
WORKER INFORMATION |
| 1215-0144 |
Overpayment Recovery Questionnaire |
| 1215-0143 |
SURVEY OF BLACK LUNG BENEFICIARIES |
| 1215-0142 |
UNIFORM BILLING CLAIM FORM |
| 1215-0141 |
SURVEY OF EXPENDITURES FOR EMPLOYEE COMPENSATION |
| 1215-0140 |
Requests to Approve Conformed Wage Classifications and Unconventional Fringe Benefit Plans Under the Davis-Bacon and Related Acts and Contract Work Hours and Safety Standards Act |
| 1215-0139 |
WAGE SURVEY OF TIPPED EMPLOYEES IN HOTELS AND RESTAURANTS |
| 1215-0137 |
Provider Enrollment Form |
| 1215-0136 |
Annual Report of Earnings |
| 1215-0133 |
MEDICAL RECORDKEEPING REQUIREMENT |
| 1215-0131 |
OFCCP Complaint Form |
| 1215-0128 |
FARM LABOR CONTRACTOR REGISTRATION - 29 CFR 40.51, 40.52 AND 40.53 |
| 1215-0126 |
CONFORMANCE RECORD SERVICE CONTRACT ACT |
| 1215-0124 |
Maintenance of Receipts for Benefits Paid by a Coal Mine Operator |
| 1215-0122 |
Requirements of a Bona Fide Profit-Sharing Plan or Trust |
| 1215-0121 |
Work Experience and Career Exploration Programs (29 C.F.R. 570.35a) |
| 1215-0120 |
29 CFR, Part 575 - Waiver of Child Labor Provisions for Agricultural Employment of 10 and 11 Year Old Minors in Hand Harvesting of Short Season Crops |
| 1215-0119 |
Requirements of a Bona Fide Thrift or Savings Plan (29 C.F.R. Part 547) and Requirements of a Bona Fide Profit-Sharing Plan or Trust (29 C.F.R. Part 549) |
| 1215-0118 |
20 CFR 702.148 MAITENANCE OF RECORDS OF COMPENSATION PAYMENTS |
| 1215-0117 |
20 CFR 702.111 MAINTENANCE OF RECORDS OF INJURY/ OCCUPATIONAL DISEASE |
| 1215-0116 |
Notice of Law Enforcement Officer's Injury or Occupational Disease (CA-721); Notice of Law Enforcement Officer's Death (CA-722) |
| 1215-0115 |
REPRESENTATIVE FEE REQUEST |
| 1215-0114 |
PHYSICIAN INFORMATION FORM |
| 1215-0113 |
Certificate of Medical Necessity |
| 1215-0112 |
Request for Earnings Information |
| 1215-0110 |
A STUDY OF ACCOMMODATIONS PROVIDED TO HANDICAPPED EMPLOYEES BY FEDERAL CONTRACTORS |
| 1215-0106 |
Request for Medical Reports |
| 1215-0105 |
Request for Employment Information |
| 1215-0103 |
FECA Medical Report Forms, Claim for Compensation |
| 1215-0101 |
NOTICE TO CARRIER OR SELF-INSURER EMPLOYER |
| 1215-0097 |
SERVICE CONTRACT ACT SURVEY QUESTIONNAIRE |
| 1215-0096 |
POLICIES AND PRACTICES OF INSURANCE CARRIERS AFFECTING APPLICANTS FOR GROUP INSURANCE |
| 1215-0091 |
DECLARATION OF CITIZENSHIP |
| 1215-0090 |
Claim adjudication process for alleged presence of pneumoconiosis |
| 1215-0089 |
CLAIMANT'S STATEMENT |
| 1215-0087 |
Survivor's Notification of Beneficiary's Death |
| 1215-0086 |
CONSTRUCTION LABOR DEMAND SYSTEM |
| 1215-0085 |
Pre-Hearing Statement |
| 1215-0084 |
Report of Changes That May Affect Your Black Lung Benefits |
| 1215-0083 |
Application for Federal Certificate of Age |
| 1215-0080 |
Application for Authority for an Institution of Higher Education to Employ Its Full-Time Students at Subminimum Wages Under Regulations 29 CFR Part 519 |
| 1215-0078 |
Representative Fee Request |
| 1215-0076 |
APPLICATION FOR LUMP SUM AWARD |
| 1215-0073 |
Application for Continuation of Death Benefit for Student |
| 1215-0072 |
OFCCP Recordkeeping and Reporting Requirements--Supply and Service |
| 1215-0069 |
Survivor's Form for Benefits |
| 1215-0068 |
REPORT OF PAYMENTS |
| 1215-0067 |
Rehabilitation Plan and Award |
| 1215-0066 |
Request for Examination and/or Treatment |
| 1215-0065 |
REPORT OF SECTION 10(H)(1) ADJUSTMENT PAYMENTS IN SUPPORT OF CLAIM FOR REIMBURSEMENT |
| 1215-0064 |
Notice of Termination, Suspension, Reduction, or Increase in Benefit Payments |
| 1215-0063 |
NOTICE OF EMPLOYEE'S INJURY OR DEATH |
| 1215-0062 |
APPLICATION FOR SELF-INSURANCE |
| 1215-0061 |
Certification By School Official |
| 1215-0060 |
Request for State or Federal Workers' Compensation Information |
| 1215-0059 |
Notice of Issuance of Insurance Policy |
| 1215-0058 |
Operator Controversion, Operator Response, Operator Response to Schedule for Submission of Additional Evidence, and Operator Response to Notice of Claim |
| 1215-0057 |
Authorization for Release of Medical Information (Black Lung Benefits) |
| 1215-0056 |
Comparability of Current Work to Coal Mine Employment |
| 1215-0055 |
Health Insurance Claim Form |
| 1215-0054 |
Medical Travel Refund Request |
| 1215-0053 |
SPOUSE'S CERTIFICATION OF MARRIAGE |
| 1215-0052 |
Miner's Claim for Benefits Under the Black Lung Benefits Act and Employment History |
| 1215-0051 |
Carrier's or Self-Insurer's Report to Deputy Commissioner |
| 1215-0050 |
MAIL HAUL CONTRACT WAGE RATE SURVEY |
| 1215-0048 |
APPLICATION FOR A CERTIFICATE TO EMPLOY LEARNERS AT A WAGE L ESS THAN THE APPLICABLE WAGE ORDER MINIMUM UNDER THE FLSA |
| 1215-0046 |
Report of Construction Contractor's Wage Rates |
| 1215-0045 |
ACCIDENT DATA ON SCHOOL BUS DRIVERS ANNUAL REPORT |
| 1215-0038 |
APPLICATION FOR A FARM LABOR CONTRACTOR CERTIFICATE OF REGISTRATION |
| 1215-0037 |
Application for a Farm Labor Contractor or Farm Labor Contractor Employee Certificate of Registration |
| 1215-0036 |
Motor Vehicle Safety for Transportation of Migrant and Seasonal Agricultural Workers |
| 1215-0034 |
Agreement and Undertaking |
| 1215-0033 |
REPORT OF INJURY EXPERIENCE OF SELF-INSURED EMPLOYER |
| 1215-0032 |
Applications for Authority to Employ Full-Time Students at Subminimum Wages in Retail/Service Establishments/Agriculture/Institutions of Higher Education |
| 1215-0031 |
Employer's First Report of Injury or Occupational Disease; Physician's Report on Impairment of Vision; and Employer's Supplementary Report of Accident or Occupational Illness |
| 1215-0030 |
PAYROLL |
| 1215-0028 |
Economic Survey Schedule |
| 1215-0027 |
Certification of Funeral Expenses |
| 1215-0024 |
Notice of Final Payment or Suspension of Compensation Benefits |
| 1215-0023 |
Notice of Controversion of Right to Compensation |
| 1215-0022 |
Payment of Compensation Without Award |
| 1215-0018 |
APPLICATION FOR SELF-INSURANCE AND FINANCIAL STATEMENT |
| 1215-0017 |
Records to be kept by Employers - FLSA |
| 1215-0016 |
EMPLOYEE PERSONAL INTERVIEW STATEMENT |
| 1215-0013 |
Application to Employ Homeworkers; Piece Rate Measurements; and Homeworker Handbooks |
| 1215-0012 |
Application for a Certificate to Employ Learners at Subminimum |
| 1215-0011 |
EMPLOYEE MAIL INTERVIEW FORM |
| 1215-0009 |
VERIFICATION OF DATE OF BIRTH (ENGLISH) |
| 1215-0008 |
ESTABLISHMENT INFORMATION, SPANISH TRANSLATION |
| 1215-0007 |
RECEIPT FOR PAYMENT OF BACK WAGES (ENGLISH & SPANISH) |
| 1215-0006 |
WAGE TRANSCRIPTION AND COMPUTATION SHEET |
| 1215-0005 |
Applications to Employ Special Industrial Homeworkers and Workers with Disabilities |
| 1215-0001 |
Employment Information Form |