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Form |
Description |
Price |
Buy Now in Word |
EE 1 |
Claim for Benefits under Energy Employees Occupational Illness Compensation Program Act |
$9.99 | |
LS 1 |
Request for Examination and/or Treatment |
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OWCP 1 |
Agreement and Undertaking |
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WH 1 |
Economic Survey Schedule |
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WD 10 |
Report of Construction Contractor's Wage Rates |
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CA 1027 |
Request for Employment Information |
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CA 1031 |
CA- 1031- Form Letter Requesting More Information |
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CA 1032 |
Request for Information on Earnings, Dual Benefits, Dependents and Third Party Settlements |
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CA 1074 |
Evidence Required in Support of Dependency Claim |
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CA 1087 |
FECA Medical Report Forms, Claim for Compensation |
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CA 1090 |
FECA Medical Report Forms, Claim for Compensation |
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CM 1093 |
Affidavit of Deceased Miner's Condition |
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CA/EN 1108 |
Statement of Recovery Forms |
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EB/EN 1108 |
Statement of Recovery Forms |
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CA/EN 1122 |
Statement of Recovery Forms |
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CM 1159 |
Report of Arterial Gas Study |
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OWCP 1168 |
Provider Enrollment Form |
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CA 12 |
Claim for Continuance of Compensation Under the Federal Empoyees' Compensation Act |
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CA 1303 |
FECA Medical Report Forms, Claim for Compensation |
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CA 1305 |
FECA Medical Report Forms, Claim for Compensation |
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CA 1331 |
FECA Medical Report Forms, Claim for Compensation |
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CA 1332 |
FECA Medical Report Forms, Claim for Compensation |
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WH 14 |
Application for Federal Certificate of Age |
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OWCP 1500 |
Health Insurance Claim Form |
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CA 16 |
FECA Medical Report Forms, Claim for Compensation |
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OWCP 16 |
Rehabilitation Plan and Award |
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CA 17 |
Duty Status Report |
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OWCP 17 |
Rehabilitation Maintenance Certificate |
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LS 18 |
Pre-Hearing Statement |
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EE 2 |
Claim for Survivor Benefits under Energy Employees Occupational Illness Compensation Program Act |
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WH 2 |
Application for Special Industrial Homeworker's Certificate |
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CA 20 |
Attending Physician Report |
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EE 20 |
Energy Employee Occupational Illness Compensation Program Act Forms (various) |
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OWCP 20 |
Overpayment Recovery Questionnaire |
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CM 200 |
Maintenance of Receipt for Benefits Paid by a Coal Mine Operator |
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LS 200 |
Report of Earnings |
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WH 200 |
Applications for Authority to Employ Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture Under Regulations 29 CFR Part 519 |
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LS 201 |
Notice of Employee's Injury or Death |
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WH 201 |
Application for Authority for an Institution on Higher Education to Employ its Full-time Students at Subminimum Wages Under Regulations 29 CFR Part 519 |
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LS 202 |
Employer's First Report of Injury or Occupational Disease |
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WH 202 |
Applications for Authority to Employ Six or Fewer Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture Under Regulations 25 CFR Part 519 |
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LS 203 |
Employee's Claim for Compensation |
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LS 204 |
Attending Physician's Supplementary Report |
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LS 205 |
Physician's Report on Impairment of Vision |
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WH 205 |
Application for Authorization to Employ a Student-Learner at Subminimum Wages |
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LS 206 |
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LS 207 |
Notice of Controversion of Right to Compensation |
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LS 208 |
Notice of Final Payment or Suspension of Compensation Benefits |
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WH 209 |
Employment Under Special Certificate of Apprentices, Messengers and Learners (including Student Learners) |
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LS 210 |
Employer's Supplementary Report of Accident or Occupational Illness |
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CA 2231 |
Claim for Reimbursement-Assisted Reemployment |
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WH 226 |
Application for Authority to Employ Workers with Disabilities at Special Minimum Wages |
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WH 226A A |
Supplemental Data Sheet for Application for Authority to Employ Workers with Disabilities at Special Minimum Wages |
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LS 262 |
Claim for Death Benefits |
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LS 265 |
Certification of Funeral Expenses |
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LS 266 |
Application for Continuation of Death Benefit for Student (under the Longshore and Harbor Workers' Compensation Act) |
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LS 267 |
Claimant's Statement |
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