- Legal
- United States Legal Forms
- United States Federal Legal Forms
- U.S. Department of Labor
Documents
52
![Form CA-7a "Time Analysis Form"](https://data.templateroller.com/pdf_docs_html/1731/17317/1731740/form-ca-7a-time-analysis-form.png "Form CA-7a "Time Analysis Form"")
Form CA-7a "Time Analysis Form"
Size: 133 KB
2 pages
This form is supposed to be used when a federal worker claims reimbursement for more than one consecutive period of leave. The application can be submitted by federal workers during their compensation cases.
![Form CMS-1500 "Health Insurance Claim Form"](https://data.templateroller.com/pdf_docs_html/2049/20492/2049228/form-cms-1500-health-insurance-claim-form.png "Form CMS-1500 "Health Insurance Claim Form"")
Form CMS-1500 "Health Insurance Claim Form"
Size: 1 MB
4 pages
Physicians and other healthcare providers and professionals may use this legal document to submit claims for medical services. Form CMS-1500 provides information about the patient and insured, their diagnosis, treatment, and insurance details.
![Form WH-4 "Nonimmigrant Worker Information Form"](https://data.templateroller.com/pdf_docs_html/1904/19043/1904337/form-wh-4-nonimmigrant-worker-information-form.png "Form WH-4 "Nonimmigrant Worker Information Form"")
![Form EE-3 "Employment History for a Claim Under the Energy Employees Occupational Illness Compensation Program Act"](https://data.templateroller.com/pdf_docs_html/1729/17291/1729142/form-ee-3-employment-history-a-claim-under-the-energy-employees-occupational-illness-compensation-program-act.png "Form EE-3 "Employment History for a Claim Under the Energy Employees Occupational Illness Compensation Program Act"")
![Form CA-1 "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation"](https://data.templateroller.com/pdf_docs_html/1704/17042/1704283/form-ca-1-federal-employee-s-notice-traumatic-injury-and-claim-continuation-pay-compensation.png "Form CA-1 "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation"")
![Form CA-6 "Official Superior's Report of Employee's Death"](https://data.templateroller.com/pdf_docs_html/1731/17314/1731473/form-ca-6-official-superior-s-report-employee-s-death.png "Form CA-6 "Official Superior's Report of Employee's Death"")
![Form M-1 "Report for Multiple Employer Welfare Arrangements (Mewas) and Certain Entities Claiming Exception (Eces)", 2015](https://data.templateroller.com/pdf_docs_html/2049/20493/2049317/form-m-1-report-for-multiple-employer-welfare-arrangements-mewas-and-certain-entities-claiming-exception-eces.png "Form M-1 "Report for Multiple Employer Welfare Arrangements (Mewas) and Certain Entities Claiming Exception (Eces)", 2015")
![Instructions for Form M-1 "Report for Multiple Employer Welfare Arrangements (Mewas) and Certain Entities Claiming Exception (Eces)"](https://data.templateroller.com/pdf_docs_html/2049/20493/2049318/instructions-for-form-m-1-report-for-multiple-employer-welfare-arrangements-mewas-and-certain-entities-claiming-exception-eces.png "Instructions for Form M-1 "Report for Multiple Employer Welfare Arrangements (Mewas) and Certain Entities Claiming Exception (Eces)"")
![Form OWCP-17 "Rehabilitation Maintenance Certificate"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899072/form-owcp-17-rehabilitation-maintenance-certificate.png "Form OWCP-17 "Rehabilitation Maintenance Certificate"")
![Form OWCP-44 "Rehabilitation Action Report"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899071/form-owcp-44-rehabilitation-action-report.png "Form OWCP-44 "Rehabilitation Action Report"")
![Form CA-5B "Claim for Compensation by Parents, Brothers, Sisiters, Grandparents, or Grandchildren"](https://data.templateroller.com/pdf_docs_html/1741/17415/1741585/form-ca-5b-claim-for-compensation-by-parents-brothers-sisiters-grandparents-or-grandchildren.png "Form CA-5B "Claim for Compensation by Parents, Brothers, Sisiters, Grandparents, or Grandchildren"")
![Form LS-33 "Approval of Compromise of Third Person Cause of Action"](https://data.templateroller.com/pdf_docs_html/1733/17338/1733835/form-ls-33-approval-compromise-third-person-cause-action.png "Form LS-33 "Approval of Compromise of Third Person Cause of Action"")
![Form CA-7b "Leave Buy Back (Lbb) Worksheet/ Certification and Election"](https://data.templateroller.com/pdf_docs_html/1731/17317/1731741/form-ca-7b-leave-buy-back-lbb-worksheet-certification-and-election.png "Form CA-7b "Leave Buy Back (Lbb) Worksheet/ Certification and Election"")
![Form CM-911 "Miner's Claim for Benefits Under the Black Lung Benefits Act"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899067/form-cm-911-miner-s-claim-benefits-under-the-black-lung-benefits-act.png "Form CM-911 "Miner's Claim for Benefits Under the Black Lung Benefits Act"")
![Form CM-910 "Request to Be Selected as Payee"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899074/form-cm-910-request-to-be-selected-as-payee.png "Form CM-910 "Request to Be Selected as Payee"")
![Form LS-208 "Notice of Payments"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899070/form-ls-208-notice-payments.png "Form LS-208 "Notice of Payments"")
![Form LS-207 "Notice of Controversion of Right to Compensation"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899068/form-ls-207-notice-controversion-right-to-compensation.png "Form LS-207 "Notice of Controversion of Right to Compensation"")
![Form LS-801 "Waiver of Service by Registered or Certified Mail for Employers and/Or Insurance Carriers"](https://data.templateroller.com/pdf_docs_html/1904/19043/1904333/form-ls-801-waiver-service-by-registered-or-certified-mail-employers-and-or-insurance-carriers.png "Form LS-801 "Waiver of Service by Registered or Certified Mail for Employers and/Or Insurance Carriers"")
![Form LS-206 "Payment of Compensation Without Award"](https://data.templateroller.com/pdf_docs_html/1733/17338/1733837/form-ls-206-payment-compensation-without-award.png "Form LS-206 "Payment of Compensation Without Award"")
![Form LS-513 "Report of Payments"](https://data.templateroller.com/pdf_docs_html/1733/17338/1733831/form-ls-513-report-payments.png "Form LS-513 "Report of Payments"")
![Form CM-972 "Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by the U.S. Department of Labor"](https://data.templateroller.com/pdf_docs_html/1741/17415/1741575/form-cm-972-application-for-approval-of-a-representative-s-fee-in-a-black-lung-claim-proceeding-conducted-by-the-u-s-department-of-labor.png "Form CM-972 "Application for Approval of a Representative's Fee in a Black Lung Claim Proceeding Conducted by the U.S. Department of Labor"")
![Form SF-308 "Request for Wage Determination and Response to Request"](https://data.templateroller.com/pdf_docs_html/1733/17337/1733773/form-sf-308-request-wage-determination-and-response-to-request.png "Form SF-308 "Request for Wage Determination and Response to Request"")
![Form LS-204 "Attending Physician's Supplementary Report"](https://data.templateroller.com/pdf_docs_html/1732/17328/1732888/form-ls-204-attending-physician-s-supplementary-report.png "Form LS-204 "Attending Physician's Supplementary Report"")
![Form LS-262 "Claim for Death Benefits"](https://data.templateroller.com/pdf_docs_html/1733/17331/1733143/form-ls-262-claim-death-benefits.png "Form LS-262 "Claim for Death Benefits"")
![Form LS-267 "Claimant's Statement"](https://data.templateroller.com/pdf_docs_html/1733/17338/1733828/form-ls-267-claimant-s-statement.png "Form LS-267 "Claimant's Statement"")
![Form LS-426 "Request for Earnings Information"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899073/form-ls-426-request-earnings-information.png "Form LS-426 "Request for Earnings Information"")
![Form LS-271 "Application for Self-insurance"](https://data.templateroller.com/pdf_docs_html/1741/17415/1741582/form-ls-271-application-for-self-insurance.png "Form LS-271 "Application for Self-insurance"")
![Form LS-265 "Certification of Funeral Expenses"](https://data.templateroller.com/pdf_docs_html/1741/17415/1741586/form-ls-265-certification-of-funeral-expenses.png "Form LS-265 "Certification of Funeral Expenses"")
![Form LS-570 "Carrier's Report of Insurance of Policy"](https://data.templateroller.com/pdf_docs_html/1733/17338/1733832/form-ls-570-carrier-s-report-insurance-policy.png "Form LS-570 "Carrier's Report of Insurance of Policy"")
![Form 201 "Notice of Employee's Injury or Death"](https://data.templateroller.com/pdf_docs_html/1733/17334/1733495/form-201-notice-employee-s-injury-or-death.png "Form 201 "Notice of Employee's Injury or Death"")
![Form LS-200 "Report of Earnings"](https://data.templateroller.com/pdf_docs_html/1733/17338/1733836/form-ls-200-report-earnings.png "Form LS-200 "Report of Earnings"")
![Form CA-35A "Evidence Required in Support of a Claim for Occupational Disease"](https://data.templateroller.com/pdf_docs_html/1731/17314/1731493/form-ca-35a-evidence-required-in-support-a-claim-occupational-disease.png "Form CA-35A "Evidence Required in Support of a Claim for Occupational Disease"")
Form CA-35A "Evidence Required in Support of a Claim for Occupational Disease"
Size: 131 KB
17 pages
![Form LS-272 "Application to Write Longshore Insurance"](https://data.templateroller.com/pdf_docs_html/1733/17338/1733829/form-ls-272-application-to-write-longshore-insurance.png "Form LS-272 "Application to Write Longshore Insurance"")
![Form CM-911A "Employment History"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899065/form-cm-911a-employment-history.png "Form CM-911A "Employment History"")
![Form CA-1108 "Long Form Statement of Recovery"](https://data.templateroller.com/pdf_docs_html/1899/18990/1899076/form-ca-1108-long-form-statement-recovery.png "Form CA-1108 "Long Form Statement of Recovery"")
![Form CA-1122 "Short Form Statement of Recovery"](https://data.templateroller.com/pdf_docs_html/1731/17317/1731743/form-ca-1122-short-form-statement-recovery.png "Form CA-1122 "Short Form Statement of Recovery"")
![Form 1-65 "Emergency Information"](https://data.templateroller.com/pdf_docs_html/232/2320/232083/form-1-65-emergency-information.png "Form 1-65 "Emergency Information"")
![Form 1010 "Request of Authorization/Carrier or Self Insured Employer Response"](https://data.templateroller.com/pdf_docs_html/334/3348/334855/form-1010-request-authorization-carrier-or-self-insured-employer-response.png "Form 1010 "Request of Authorization/Carrier or Self Insured Employer Response"")
![Instructions for Form ETA-9141C "Application for Prevailing Wage Determination"](https://data.templateroller.com/pdf_docs_html/2036/20363/2036353/instructions-for-form-eta-9141c-application-for-prevailing-wage-determination.png "Instructions for Form ETA-9141C "Application for Prevailing Wage Determination"")
Instructions for Form ETA-9141C "Application for Prevailing Wage Determination"
Size: 284 KB
5 pages
