(04/2020) Administrative Subpoena to Appear and Testify at a Hearing
United States Department of Labor
OFFICE OF ADMINISTRATIVE LAW JUDGES
In Re:
(Plaintiff/Complainant/Claimant)
v.
(Defendant/Respondent/Employer/Carrier)
OALJ Case No:
SUBPOENA TO APPEAR AND TESTIFY AT A HEARING
To:
YOU ARE COMMANDED to appear at the time, date, and place set forth below to testify at a formal hearing in the above
captioned proceeding. When you arrive, you must remain at the location of the proceeding until the judge or a court officer allows
you to leave. If you are an organization that is not a party in this case, you must designate one or more officers, directors, or
managing agents, or designate other persons who consent to testify on your behalf about the following matters, or those set forth in an
attachment:
Place of Testimony:
Date:
Time:
YOU MUST ALSO BRING WITH YOU the following documents, electronically stored information, or objects
(blank if not applicable):
The provisions of Code of Federal Regulations (CFR) 29 C.F.R. §§18.56(c) and 18.52(a), relating to your protection as a person
subject to a subpoena, and 29 CFR §§18.56(d) and 18.56(e), relating to your duty to respond to this subpoena and the potential
consequences of not doing so, are attached.
This subpoena is issued upon the application of (indicate attorney/representative for named party):
(Person requesting subpoena) (Address and Telephone Number)
Name Address
City
State Zip CodePhone Number
IN WITNESS WHEREOF the undersigned United
States Department of Labor Administrative Law
Judge has digitally signed this subpoena.
Signature of U.S. Administrative Law Judge
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Address
City State Zip Code
Bar Number
If this subpoena commands the production of documents, electronically stored information, or tangible things, a copy of this subpoena must
be served on each party before it is served on the person to whom it is directed. 29 C.F.R. §18.56(b)
Firm Name
click to sign
signature
click to edit
NOTICE: This subpoena is only valid in proceedings before the Office of
Administrative Law Judges or Office of Workers' Compensation Programs.
To be valid, this subpoena must bear the digital signature of a Department of
Labor (DOL) administrative law judge.
Rules of Practice and Procedure for Administrative Hearings
Before the Office of Administrative Law Judges
[Code of Federal Regulations, Title 29, Part 18]
29 C.F.R. §18.56 Subpoenas
(c)(3) Motion to quash or modify subpoena. Provides that the person against
whom the subpoena is directed may file a motion to quash or modify the
subpoena, setting forth why the subpoena should be withdrawn or why it
should be limited in scope. Pursuant to 29 CFR §18.33(d), the Party that
requested the subpoena must file a response within 14 days after such motion
is served.
(e) Failure to comply. Provides that if the person fails to comply with a
subpoena, the party adversely affected by the failure may, when authorized
by statute or law, apply to the appropriate district court to enforce the
subpoena.
29 C.F.R. §18.22 Representation
(b) Categories of representation. Provides that any person compelled to
testify in a proceeding in response to a subpoena may be accompanied,
represented, and advised by a qualified representative.
29 C.F.R. §18.52 Protective orders
(a) In general. Upon motion by a party or person from whom discovery is
sought, and for good cause shown, the administrative law judge may make an
order to protect a party or person from annoyance, embarrassment,
oppression, or undue burden or expense, including one or more of the
following:
(1) Forbidding the disclosure or discovery;
(2) Specifying terms, including time and place, for the disclosure or
discovery;
(3) Prescribing the discovery method of discovery other than the one
selected by the party seeking discovery;
(4) Forbidding inquiry into certain matters, or limiting the scope of
disclosure or discovery to certain matters;
(5) Designating the persons who may be present while discovery is
conducted;
(6) Requiring that the deposition be sealed and opened only on the judge's
order;
(7) Requiring a trade secret or other confidential research, development or
commercial information not be revealed or be revealed only in a
specified way; and,
(8) Requiring the parties simultaneously file specified documents or
information in sealed envelopes, to be opened as the judge directs.
18 U.S.C. §1505 Obstruction of proceedings
Whoever acts with an improper purpose, including making a false or
misleading statement or by withholding, concealing, altering or destroying a
document or other information, or by threats or force influences, obstructs or
impedes the due an proper administration of law under which any pending
proceeding before an agency of the United States, shall be fined and
imprisoned not more than 5 years.
HIPAA NOTICE: In regard to the Privacy of Individually Identifiable Health
Information under the Health Insurance Portability and Accountability Act of 1996, if
this subpoena does not bear the digitized signature of a DOL administrative law judge, it
is not valid under 45 C.F.R. §§164.512(e), 164.512(f) or 164.512(l).
Federal Rules of Civil Procedure [Applied by 29 C.F.R. §18.10(a)]
Rule 45 Subpoena
(c) Protecting a Person Subject to a Subpoena.
(c)(1) Provides that the party or attorney responsible for issuing and serving a subpoena
must take reasonable steps to avoid imposing undue burden or expense on a person
subject to the subpoena and the issuing court must enforce this duty and impose an
appropriate sanction on a party or attorney who fails to comply.
(c)(2) Provides that, unless ordered to appear for a deposition or hearing, a person
ordered to produce documents, electronically stored information, or tangible things, or to
permit inspection of premises, need be present at the place of production or inspection.
The person subject to the subpoena may also object to producing the documents,
electronically stored information, or tangible things, or to permit inspection of premises,
by giving written notice to the party or attorney responsible for issuing and serving the
subpoena. The written objection must be made before the date of requested performance
or 14 days from receiving the subpoena, whichever is earlier.
(c)(3) Provides that the person subject to the subpoena may file a motion to quash (stop)
or limit the scope of a subpoena because there is not enough time to comply with the
subpoena, the person would incur substantial expense requiring travel more than 100
miles to comply, privileged or protected matter would be disclosed, or other undue
burden would result.
(d) Duties in Responding to a Subpoena.
(d)(1) Requires that the person responding to the subpoena produce documents as they
are kept in the ordinary course of business or must organize and label them to
correspond to the categories in the subpoena. If the subpoena does not specify a form
for producing electronically stored information, the person responding must produce it
in the form in which it is usually maintained or in another reasonably usable form.
(d)(2) Require that a person withholding subpoenaed information because it is
privileged information or subject to protection as trial-preparation material must
expressly make such claim and describe the nature of the withheld documents,
communications, or tangible things in a manner that, without revealing the privileged or
protected information, will enable the parties to assess the claim of privilege or
protection.
(e) Contempt. Provided that a U.S. District Court may hold a person in contempt if the
person fails to obey the subpoena without adequate excuse, such as those reasons in Rule
45(c)(3).
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(04/2020) Administrative Subpoena to Appear and Testify at a Hearing
(04/2020) Administrative Subpoena to Appear and Testify at a Hearing
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PROOF OF SERVICE
Person served (print name) Date of Service
Place of Service Manner of Service
DECLARATION OF SERVER
I declare under penalty of perjury under the laws of the United States of America that the foregoing information contained
in the Proof of Service is true and correct.
Signature of Server
Date
On
I received this subpoena and served it pursuant to 29 CFR §18.56(b) as follows:
I have also tendered to the witness fees for one day's attendance and the mileage allowed by law, in the amount of
I have not tendered witness fees for one day's attendance and for the mileage allowed by law.
$
Name of Server (Print Name)
Address:
City:
ZIP:
State: