Employee Benefits Security Administration

EBSA

Federal Forms

Forms
OMB NumberTitle
1210-0170 Annual Information Return/Report of Employee Benefit Plan- SECURE Act
1210-0169 No Surprise Act: IDR Process
1210-0168 Opt-in State Balance Bill Process
1210-0167 COBRA Continuation Coverage: Premium Assistance
1210-0166 Pension Benefit Statement
1210-0165 Fiduciary Duties Regarding Proxy Voting and Shareholder Rights
1210-0164 Registration Requirements to Serve as a Pooled Plan Provider to Pooled Employer Plans
1210-0163 Improving Investment Advice for Workers & Retirees Prohibited Transaction Exemption
1210-0162 Prudence and Loyalty in Selecting Plan Investments and Exercising Shareholder Rights
1210-0161 EBSA Participant Assistance Program Customer Survey
1210-0160 Notice for Health Reimbursement Arrangements Integrated with Individual Health Insurance Coverage
1210-0159 Insurance Marketing Organization Exemption
1210-0158 Insurance and Annuity Contracts and Mutual Fund Principal Underwriters (PTE 1984-24)
1210-0157 Prohibited Transaction Class Exemption for Principal Transactions
1210-0156 Best Interest Contract Prohibited Transaction Exemption
1210-0155 Conflicted Investment Advice Rule Fiduciary Exception Disclosure Requirements
1210-0154 Focus Groups for Evaluating the Effectiveness of Employee Retirement Income Security Act Section 408(b)(2) Disclosure Requirements
1210-0153 Alternative Reporting Methods for Apprenticeship and Training Plans and Top Hat Plans
1210-0152 Coverage of Certain Preventive Services Under the Affordable Care Act-For-Profit Entities
1210-0151 Focus Groups and Survey Regarding Pension Benefit Statements
1210-0150 Coverage of Certain Preventive Services under the Affordable Care Act—Private Sector
1210-0149 Notice to Employees of Coverage Options Under Fair Labor Standards Act Section 18B
1210-0148 Multiple Employer Welfare Arrangement Administrative Law Judge Administrative Hearing Procedures
1210-0147 Summary of Benefits and Coverage and Uniform Glossary Required Under the Affordable Care Act
1210-0146 Request for Assistance from the Department of Labor, Employee Benefits Security Administration
1210-0145 Plan Asset Transactions Determined by In-House Asset Managers under Prohibited Transaction Class Exemption 96-23
1210-0144 Affordable Care Act Internal Claims and Appeals and External Review Procedures for ERISA Plans
1210-0143 Affordable Care Act Enrollment Opportunity Notice—Prohibition on Lifetime Limits
1210-0142 Patient Protection and Affordable Care Act Patient Protection Notice
1210-0141 Affordable Care Act Advance Notice of Rescission
1210-0140 Affordable Care Act Grandfathered Health Plan Disclosure, Recordkeeping Requirement, and Change in Carrier Disclosure
1210-0139 Affordable Care Act Enrollment Opportunity Notice Relating to Extension of Dependent Coverage
1210-0138 Mental Health Parity and Addiction Equity Act of 2008 Notices
1210-0137 Model Employer Children's Health Insurance Program Notice
1210-0136 Genetic Information Nondiscrimination Act of 2008 Research Exception Notice
1210-0135 Request to the Department of Labor for Expedited Review of Denial of COBRA Premium Reduction
1210-0134 Investment Advice Participants and Beneficiaries
1210-0133 Employee Retirement Income Security Act Section 408(b)(2) Regulation
1210-0132 Default Investment Alternatives under Participant Directed Individual Account Plans
1210-0131 Access to Multiemployer Plan Information
1210-0130 Statutory Exemption for Cross-Trading of Securities
1210-0129 HDCI 2 Survey of Group Health Plans
1210-0128 Plan Asset Transactions Determined by Independent Qualified Professional Asset Managers under Prohibited Transaction Exemption 1984-14
1210-0127 Abandoned Individual Account Plan Termination
1210-0126 Defined Benefit Plan Annual Funding Notice
1210-0125 Employee Retirement Income Security Act of 1974 Investment Manager Electronic Registration
1210-0124 Acquisition and Sale of Trust Real Estate Investment Trust Shares by Individual Account Plans Sponsored by Trust Real Estate Investment Trusts
1210-0123 Notice Requirements of the Health Care Continuation Coverage Provisions
1210-0122 Employee Retirement Income Security Act Blackout Period Notice
1210-0121 Consent to Receive Employee Benefit Plan Disclosures Electronically
1210-0120 Notice of Opportunity to Enroll
1210-0119 Petition for Finding under the Employee Retirement Income Security Act Section 3(40)
1210-0118 Voluntary Fiduciary Correction Program
1210-0117 Registration for EFAST-2 Credentials
1210-0116 Annual Report for Multiple Employer Welfare Arrangements
1210-0115 Prohibited Transaction Class Exemption for Cross-Trades of Securities by Index and Model-Driven Funds (PTCE 2002-12)
1210-0114 Disclosures by Insurers to General Account Policyholders
1210-0113 National Medical Support Notice-Part B
1210-0112 Furnishing Documents to the Secretary of Labor on Request Under Employee Retirement Income Security Act Section 104(a)(6)
1210-0111 Prohibited Transaction Class Exemption 1998-54 Relating to Certain Employee Benefit Plan Foreign Exchange Transactions Executed Pursuant to Standing Instructions
1210-0110 Annual Information Return/Report of Employee Benefit Plan
1210-0109 Survey of Form 5500 Series Filer Burden
1210-0107 Notice of Group Health Plan's Use of Transition Period and Posting Thereof
1210-0106 Calculation and Disclosure of Documentation of Eligibility for Exemption
1210-0105 Notice to Participants and Beneficiaries and the Federal Government of Electing One Percent Increased Cost Exemption
1210-0104 Collective Investment Funds Conversion Transactions, Prohibited Transaction Class Exemption 1997-41
1210-0103 Establishing Creditable Coverage under Group Health Plans
1210-0102 Notice of Pre-Existing Condition Exclusion Under Group Health Plans
1210-0101 Notice of Special Enrollment Rights under Group Health Plans
1210-0100 Definition of Plan Assets—Participant Contributions
1210-0098 Process for Expedited Approval of an Exemption for Prohibited Transaction, Prohibited Transaction Class Exemption 1996-62
1210-0097 Notice of Pension Payback Program
1210-0095 Prohibited Transaction Class Exemption 1988-59, Residential Mortgage Financing Arrangements Involving Employee Benefit Plans
1210-0094 Prohibited Transaction Class Exemption 1985-68 to Permit Employee Benefit Plans to Invest in Customer Notes of Employers
1210-0092 Prohibited Transaction Class Exemption 75-1, Security Transactions with Broker-Dealers, Reporting Dealers, and Banks
1210-0091 Settlement Agreements Between a Plan and a Party in Interest
1210-0090 Disclosures for Participant Directed Individual Account Plans
1210-0089 Delinquent Filer Voluntary Compliance Program
1210-0088 MARKET RATE ALTERNATIVE INVESTMENT CLEARINGHOUSE
1210-0087 PENSION AND HEALTH BENEFITS SUPPLEMENT TO THE SEPTEMBER 1994 CURRENT POPULATION SURVEY
1210-0086 EMPLOYEE BENEFITS SUPPLEMENT (APRIL 1993 SUPLEMENT TO THE CURRENT POPULATION SURVEY)
1210-0085 Foreign Currency Transactions, Prohibited Transaction Class Exemption 1994-20
1210-0084 Employee Retirement Income Security Act of 1974 Technical Release 1991-1
1210-0083 PTE 1990-1; Insurance Company Pooled Separate Accounts
1210-0082 Bank Collective Investment Funds, Prohibited Transaction Class Exemption 1991-38
1210-0081 Prohibited Transaction Exemption 77-10
1210-0080 Prohibited Exemption 786-6
1210-0079 Prohibited Transaction Class Exemption 91-55: Transactions Between Individual Retirement Accounts and Authorized Purchasers of American
1210-0078 DECEMBER 1989 RECEIPT OF PENSION BENEFITS SUPPLEMENT TO CPS
1210-0076 Loans to Plan Participants and Beneficiaries Who Are Parties In Interest With Respect to The Plan Regulation
1210-0074 Prohibited Transaction Class Exemption T88-1
1210-0073 APPLICATION PROCEDURES FOR EXEMPTION FROM PROHIBITED TRANSACTIONS UNDER FERSA, SHORT TITLE: FERSA EXEMPTION PROCEDURE (INTERIM RULE)
1210-0071 PROPOSED REGULATION REGARDING ALLOCATION OF FIDUCIARY RESPONSIBILITY, FEDERAL RETIREMENT THRIFT INVESTMENT BOARD
1210-0070 AUGUST 1988 CPS RETIREE HEALTH INSURANCE BENEFITS SUPPLEMENT
1210-0069 PLAN ASSETS REPORTING ALTERNATIVE REGULATION
1210-0066 Employee Retirement Income Security Act Procedure 1976-1; Advisory Opinion Procedure
1210-0065 Securities Lending by Employee Benefit Plans, Prohibited Transaction Exemption 2006-16
1210-0064 Class Exemption for Certain Transactions Involving Purchase of Securities where Issuer May Use Proceeds to Reduce or Retire Indebtedness to Parties in Interest (PTE 1980-83)
1210-0063 Prohibited Transaction Class Exemption 1992-6: Sale of Individual Life Insurance or Annuity Contracts by a Plan
1210-0062 Prohibited Transaction Class Exemption 82-63
1210-0061 Employee Retirement Income Security Act Prohibited Transaction Class Exemption 1981-8, Investment of Plan Assets in Certain Types of Short-Term Investments
1210-0060 Employee Retirement Income Security Act of 1974 Section 408(a) Prohibited Transaction Provisions Exemption Application Procedure
1210-0059 Employee Retirement Income Security Act Prohibited Transaction Exemption 1986-128 For Securities Transactions Involving Employee Benefit Plans and Broker-Dealers
1210-0058 Prohibited Transaction Class Exemptions for Multiple Employer Plans and Multiple Employer Apprenticeship Plans—PTE 1976-1, PTE 1977-10, PTE 1978-6
1210-0054 Class Exemption 90-1 Certain transactions involving insurance company pooled separate accounts(formerly 78-19)
1210-0053 Employee Benefit Plan Claims Procedure Under the Employee Retirement Income Security Act
1210-0049 Prohibited Transaction Class Exemption for Certain Transactions Between Investment Companies and Employee Benefit Plans (PTE 1977-4)
1210-0048 Suspension of Pension Benefits Pursuant to Regulations
1210-0046 LOANS TO EMPLOYEE STOCK OWNERSHIP PLANS (ESOPS) DOL REGULATION 2550.408B-3
1210-0045 PROHIBITED TRANSACTION CLASS EXEMPTION 84-24 - REPLACEMENT FOR 77-9
1210-0044 29 CFR PART 220 AIRLINE EMPLOYEE PROTECTION PROGRAM
1210-0042 1983 SURVEY OF CONSUMER FINANCES (INTERAGENCY COOPERATIVE EFFORT)
1210-0041 REGULATION RELATING TO SUPPLEMENTAL PAYMENTS
1210-0040 Employee Retirement Income Security Act Summary Annual Report Requirement
1210-0039 Summary Plan Description Requirements Under the Employee Retirement Income Security Act of 1974, as Amended
1210-0037 THE MEDIATION OF GRIEVANCES IN THE COAL INDUSTRY
1210-0035 THE EFFECTIVENESS OF AREA LABOR-MANAGEMENT COMMITTEES
1210-0034 Alternative Method of Compliance for Certain Simplified Employee Pensions
1210-0017 SIMPLIFIED ANNUAL REPORT FORMAT
1210-0016 Annual Information Return/Report
1210-0012 TRUSTEESHIP REPORTS
1210-0011 SURETY COMPANY ANNUAL REPORT
1210-0010 ELIGIBILITY DATA FORM
1210-0009 LABOR ORGANIZATION OFFICER AND EMPLOYEE REPORT
1210-0004 EMPLOYER ACTIVITY REPORTS
1210-0001 LABOR ORGANIZATIONS AND AUXILIARY REPORT

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