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Customer Service Intake Form
Request for Assistance from the Department of Labor, Employee Benefits Security Administration
Request for Assistance Privacy Act and PRA Notices Screenshots (Spanish)
Customer Service Intake Form
OMB: 1210-0146
OMB.report
DOL/EBSA
OMB 1210-0146
ICR 202207-1210-002
IC 198333
Customer Service Intake Form
( )
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1210-0146 can be found here:
2024-02-23 - Extension without change of a currently approved collection
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File Modified
0000-00-00
File Created
2014-09-18
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