Notice of Designation of Representative Form, Form 75

• Legal Form Number: 75
• Section: Office of Congressional Workplace Rights (United States)

advancing workplace rights, safety and health, and accessibility in the legislative branch

Office of Congressional Workplace Rights

LABOR MANAGEMENT – NOTICE OF DESIGNATION OF

REPRESENTATIVE FORM

Petitioner CASE NO.

and

Respondent

Section 1 – Party

Section 2 – Representative Information

Name: Tel. #:

Title: Cell #:

Address:

City: State: ZIP:

E-mail:

The person named above represents the party named in Section 1 in this case. Please serve this representative with all

written communications, except for subpoenas. This designation remains effective until it is revoked or a new

designation is filed. Please e-mail completed forms to LMR@ocwr.gov; mail or drop form off in Room LA-200, John

Adams Building, 110 Second Street SE, Washington, DC 20540-1999; or fax to (202) 426-1913.

Name (please print or type) Signature

OCWR Form 75 – Revised 7/2022

Room LA-200, John Adams Building · 110 Second Street, SE · Washington, DC 20540-1999 · t/202.724.9250 · f/202.426.1913

www.ocwr.gov