301 Request for Assistance from Department of Labor, EBSA (E

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

Request for Assistance Web Option Screenshots (English)

Customer Service Intake Form

OMB: 1210-0146

Document [docx]
Download: docx | pdf

Current Form







New Enhanced Form



For all selected options (except the opt out) if submitter has an open inquiry – they will receive this screen.

If there is no open inquiry and they select any option but (the opt out, or the SSA notice), they will receive this confirmation screen.

Exit confirmation - after they selected Exit Request for Assistance.

If submitter selected the SSA notice, they would get these screens:

If opt out was selected – these screens will appear. Important note: This is how the form operates now for this selection.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorMansur, Leyla - EBSA
File Modified0000-00-00
File Created2025-09-18

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