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