U.S. Department of Labor, Employee Benefits Security Administration

Privacy Act Notice

DOL is strongly committed to maintaining the privacy of your personal information. With respect to the collection, use and disclosure of personal information, DOL makes every effort to ensure compliance with applicable federal law, including, but not limited to, The Privacy Act of 1974.

The Privacy Act of 1974 requires that when we ask you for information we tell you our legal right to ask for the information, why we are asking you for it, and how it will be used. We must also tell you what could happen if we do not receive it and whether your response is voluntary, required to obtain a benefit, or mandatory. Our legal authority to ask for the information is sections 1134 and 1143 of the Employee Retirement Income Security Act of 1974 (ERISA) P.L. 93-406. However, provision of this information is voluntary. We are asking for this information to assist EBSA in responding to your inquiry in an expedited manner. If you do not provide the information, EBSA will need to contact you by phone to obtain the information necessary to respond to your inquiry which will increase the time for a response. We do not sell the information that we collect. The personal information that you give us will be used only in connection with responding to your inquiry.

We use contractors to perform various website and database functions. When we do, we make sure that the agreement language with the contractor ensures the security, confidentiality and integrity of any personal information to which the contractor may have access in the course of contract performance.

We may disclose the information you give us if authorized or required by Federal law, such as the Privacy Act. We may also disclose this information to the relevant employee benefit plan administrator, third party administrator, insurance carrier, employee’s employer (or former employer) or other party as necessary to facilitate a resolution to the circumstance presented by the individual seeking assistance from the agency. You may have access to any of the information we collect about you.

While providing this information through our online form is secure, electronic mail is not secure. Therefore, we suggest that you don’t send personal information to us by email. We will only send general information to you by email.

Paperwork Reduction Act Statement

According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.

The public reporting burden for this voluntary collection of information is estimated to range from fifteen (15) minutes to one (1) hour, with an average of thirty (30) minutes per response, including time for reviewing general information about requesting assistance, gathering information, completing and reviewing the collection of information, and uploading attachments if applicable. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email ebsa.opr@dol.gov and reference the OMB Control Number 1210-0146. Note: Please do not return the completed request for assistance to this address.