Customer Service Intake Form

Request for Assistance from the Department of Labor, Employee Benefits Security Administration

OMB: 1210-0146

IC ID: 198333

Documents and Forms

Document Name Document Type
Form 301 Customer Service Intake Form Form and Instruction
301 Request for Assistance from Department of Labor, EBSA (English Paper Version) Request for Assistance Paper Option (English).pdf www.askebsa.dol.gov/WebIntake/Home.aspx Form and Instruction
301 Request for Assistance from Department of Labor, EBSA (Spanish Paper Version) Request for Assistance Paper Option (Spanish).pdf www.askebsa.dol.gov/WebIntake/Home.aspx?l=es Form and Instruction
Request for Assistance Privacy Act and PRA Notices Screenshots (English).pdf www.askebsa.dol.gov/WebIntake/Home.aspx Other-Web Screenshots of Privacy Act and PRA Notices (English)
Request for Assistance Privacy Act and PRA Notices Screenshots (Spanish).pdf www.askebsa.dol.gov/WebIntake/Home.aspx?l=es Other-Web Screenshots of Privacy Act and PRA Notices (Spanish)
301 Request for Assistance from Department of Labor, EBSA (English Web Option Screenshots) Request for Assistance Web Option Screenshots (English).pdf www.askebsa.dol.gov/WebIntake/Home.aspx Form and Instruction
301 Request for Assistance from Department of Labor, EBSA (Spanish Web Option Screenshots) Request for Assistance Web Option Screenshots (Spanish).pdf www.askebsa.dol.gov/WebIntake/Home.aspx?l=es Form and Instruction