Office of Congressional Workplace Rights
110 Second Street, SE, Room LA-200 | Washington, DC 20540-1999
(202) 724-9250 (O) | (202) 426-1913 (F)
www.ocwr.gov
OCWR Form 1.07(a) 03/2020
Office of Congressional Workplace Rights
Notice of Designation of Representative Form
Employee name(s): ____________________________________________
Employing office: _____________________________________________
OCWR Case no. (if any): _______________________________________
Instructions
A party wishing to be represented by an entity, a firm, or a different individual must file
this written Notice of Designation of Representative Form with the Office of
Congressional Workplace Rights (OCWR). Only one person, firm, or other entity may be
designated as a representative for a party for the purpose of receiving service, unless the
hearing officer assigned to the case or the OCWR Executive Director approves a written
request to have more than one representative. A representative may be, but is not required
to be, an attorney. If the representative is an attorney, he or she may sign this Notice of
Designation of Representative Form on behalf of the party.
The individual or entity listed as the designated representative shall remain in that
capacity and stay on file at the OCWR unless or until the represented partyor the
representative with notice to the partyinforms the OCWR Executive Director in
writing that this designation is modified or revoked. All service of documents shall be
sent to the designated representative unless or until such time as the represented party
or the representative with notice to the partyspecifies otherwise and informs the
Executive Director in writing that the designation of representative has been modified or
revoked.
Please complete the next page of this form and submit it to the OCWR by one of the
following methods: email (OCWRefile@ocwr.gov), fax (202-426-1913), or hand-delivery
to the Library of Congress, John Adams Building, 110 Second Street, SE, Room LA-200,
Washington, DC 20540.
Notice of Designation of Representative Form (continued) Page 2 of 2
OCWR Form 1.07(a) 03/2020
O
Notice of Designation of Representative
I designate the following as my representative in connection with the above-referenced
matter:
Name of representative: ___________________________________________________
If a law firm or legal office is the representative, please list the specific name(s) of the
attorney(s) at the firm or office who are representing you:
_______________________________________________________________________
Preferred phone no.: ___________________________________Ext.:_______________
Secondary phone no.: __________________________________Ext.:_______________
Fax: ___________________________________________________________________
Email: _________________________________________________________________
Mailing address:
________________________________________________________________________
________________________________________________________________________
Has a claim already been filed with the OCWR in this matter? Yes No
Name of person making the designation:
_______________________________________________________________________
Signature Date
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signature
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