LM-20 Agreement and Activities Report

U.S. Department of Labor Office of Labor-Management

Standards

Washington, DC 20210

FORM LM-20 AGREEMENT AND ACTIVITIES REPORT

Form approved Office of Management

and Budget No. 1245-0003

Expires 08/31/2026

For Official Use Only

E

READ THE INSTRUCTIONS CAREFULLY BEFORE PREPARING THIS REPORT.

This report is mandatory under P.L. 86-257, as amended. Failure to comply may result in criminal prosecution, fines, or civil penalties as provided by 29 U.S.C. 439 or 440. Required of persons, including labor relations consultants and other individuals and organizations, under Section 203(b) of the Labor-Management Reporting and Disclosure Act of 1959, as amended (LMRDA).

^{1. File Number:} C-

Person Filing
2. Name and mailing address (include ZIP Code): Name____________________________________________________________				3. Any other address where records necessary to verify this report are kept: Name________________________________________________________
Title_____________________________________________________________				Title_________________________________________________________
Organization____________________________________________________ Employer Identification Number_____________________________________				Organization_________________________________________________ P.O. Box, Bldg., Room No., if any_________________________________
P.O. Box, Bldg., Room No., if any____________________________________				Street______________________________________________________
Street_________________________________________________________				City_________________________________________________________
City____________________________________________________________				State___________________________ ZIP Code + 4__________________
State______________________________ ZIP Code + 4__________________
4. Date fiscal year ends:	Type of person: Individual	b.	Partnership	c.	Corporation	d.	Other (Specify):

Nature of Agreement or Arrangement
6. Full name and address of employer with whom made (include ZIP Code): Name______________________________________________________________ Organization_________________________________________________________ Trade Name, if any___________________________________________________ Employer Identification Number__________________________________________ P.O. Box, Bldg., Room No., if any_______________________________________ Street______________________________________________________________ City________________________________________________________________ State____________________________ Zip Code +4_________________________	7. Date entered into:
	8. Name of person(s) through whom made: (a) Employer Representative (to be completed by the Primary Consultant): Name and Title ___________________________________ OR (b) Primary Consultant (to be completed by the Sub-consultant) : Name and Title ___________________________________ Employer Identification Number _________________ Address: ________________________________________

Signatures

10. Terms and conditions (Explain in detail; see instructions. Written agreements must be attached.):

Specific Activities to be Performed
11. For each activity, separately list in detail the information required (See instructions): a. Nature of activity:
11.b. Period during which performed:	11.c. Extent performed:
11.d. Name and address through whom performed: Name________________________________________________________ Title_________________________________________________________ Type of Person o Employee of Consultant o Sub-consultant	Additional name and address through whom performed, if any: Name________________________________________________________ Title_________________________________________________________ Type of Person o Employee of Consultant o Sub-consultant
Organization Name____________________________________________ Employer Identification Number__________________________________	Organization Name____________________________________________ Employer Identification Number__________________________________
P.O. Box, Bldg., Room No., if any_________________________________	P.O. Box, Bldg., Room No., if any_________________________________
Street______________________________________________________	Street______________________________________________________
City_________________________________________________________	City_________________________________________________________
State________________________________ ZIP Code + 4____________	State________________________________ ZIP Code + 4____________
12.a. Identify subject groups of employees:	12.b. Identify subject labor organizations:

Form LM-20 (XXXX)

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