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- Click ‘Get Form’ to open the dept labour document in the editor.
- Begin by entering your OWCP case number and Social Security number in the designated fields. This information is crucial for identifying your claim.
- Fill in your name, address, and the date of the accident, illness, or injury. Ensure that all details are accurate to avoid any delays in processing.
- Specify the part or parts of your body that were injured. Be as detailed as possible to provide clarity on your claim.
- Review the retainer section carefully. Confirm that you understand the terms regarding representation and fees before signing.
- Once completed, ensure both you and your attorney sign and date the form where indicated. This step is essential for validation.
- Finally, submit the form in duplicate as required by the Office of the Deputy Commissioner.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 1998 | 4.8 Satisfied (263 Votes) |
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Related links
Welcome to the United States Department of Labor. Learn more about our work. Explore the new beta.dol.gov website! Enjoy streamlined navigation and modernRead more
Nov 7, 2017 In July this year, 72 JSE-listed companies were identified as the subject of employment equity reviews by the Department of Labour