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

All forms are Microsoft Word documents that are completely fillable and easy to use, save, and copy.  Our MS Office-certified designers make current, correct, and easy government forms in Word with automatic form fill features. We always do a careful proof of each form to be sure it looks just like the federal form. We are happy to answer questions that you have, and we usually e-mail your document to you right away! The only information we receive from PayPal to contact you is your email address, so if you prefer that we send your form to another e-mail or if you typed it in wrong, e-mail us (forms@formsinword.com) about where to send your form (include your phone number). Thank you for using Forms in Word! Questions? E-mail or call 907-745-5674 for personalized service!

Form

Description

Price

Buy Now in Word

CA-1

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

$15.99

CA-2

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

$15.99

CA-2

DFEC CA-20, Attending Physician's Report

$15.99

CA-2a

DFEC CA-2a, Notice of Recurrence

$15.99

CA-35 (A-H)

DFEC CA-35, Evidence Required in Support of a Claim for Occupational Disease (17 pages)
$15.99

CA-5

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

$15.99

CA 5a DFEC CA-5b, Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
$15.99
 

CA-6

DFEC CA-6, Official Supervisor's Report of Employee's Death

$15.99

CA-7

DFEC CA-7, Claim for Compensation

$15.99

CA-7A

DFEC CA-7a, Time Analysis Form

$15.99

CA-7b

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

$15.99

CA 10

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

$15.99
CA 12 DFEC CA-12, Claim For Continuance of Compensation Under the Federal Employees' Compensation Act
$15.99
CA-17

DFEC CA-17, Duty Status Report

$15.99

CA 278

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

$15.99
CA 721 DFEC CA-721, Notice of Law Enforcement Officer's Injury Or Occupational Disease
$15.99
CA722 DFEC CA-722, Notice of Law Enforcement Officer's Death
$15.99
CA 1031 DFEC CA-1031, Letter to Dependants to Verify Claimant Support
$15.99
CA 1074 DFEC CA-1074, Letter to Parents in Death Claim Development
$15.99
CA 1108 DFEC CA-1108, Statement of Recovery Letter with Long Form
$15.99
CA 1122 DFEC CA-1122, Statement of Recovery Letter with Short Form
$15.99
CA 2231 DFEC CA-2231, Claim for Reimbursement Assisted Reemployment
$15.99
CC-4

Complaint of Discrimination in Employment Under Federal Government Contracts

$40

CM-1093

CM-1093, Affidavit of Deceased Miner's Condition

$15.99

CM-1159

CM-1159, Report of Arterial Blood Gas Study

$15.99

CM-2907

CM-2907, Report of Ventilatory Study

$15.99

CM-2970

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

$15.99

CM-2970a

CM-2970a, Operator Response to Notice of Claim

$15.99

CM-623

CM-623, Representative Payee Report

$15.99

CM-623S

CM-623S, Representative Payee Report

$15.99

CM-787

CM-787, Physician's/Medical Officer's Statement

$15.99

CM-893

CM-893, Certificate of Medical Necessity

$15.99

CM-908

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

$15.99

CM-910

CM-910, Request To Be Selected As Payee

$15.99

CM-911

CM-911, Miner's Claim For Benefits Under The Black Lung Benefits Act

$40

CM-911a

CM-911a, Employment History

$15.99

CM-912

CM-912, Survivor's Form For Benefits Under The Black Lung Benefits Act

$15.99

CM-913

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

$40

CM-918

CM-918, Coal Mine Employment Affidavit

$15.99

CM-929

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

$15.99

CM-933

CM-933, Roentgenographic Interpretation

$15.99

CM-933b

CM-933b, Roentgenographic Quality Rereading

$15.99

CM-936

CM-936, Authorization For Release Of Medical Information (Black Lung Benefits)

$15.99

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