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
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1210-0146 can be found here:
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| File Type | application/pdf |
| File Modified | 0000-00-00 |
| File Created | 2014-09-18 |