Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act

Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act

OMB: 1215-0160

IC ID: 43808

Documents and Forms

Document Name Document Type
Form LS-201 proposed Regulations Governing the Administration of the Longshore and Harbor Workers' Compensation Act Form
ESA 100.doc Other-Recordkeeping
LS-201 proposed Notice of Employee's Injury or Death LS-201 proposed.pdf www.dol.gov/esa/owcp/dlhwc/ls-201.pdf Form
LS-513 proposed Report of Payments LS-513 proposed.pdf Form
LS-267 proposed Claimant's Statement LS-267 proposed.pdf www.dol.gov/esa/owcp/dlhwc/LS-267.pdf Form
LS-203 proposed Employee's Claim for Compensation LS-203 proposed.pdf www.dol.gov/esa/owcp/dlhwc/ls-203.pdf Form
LS-262 proposed Claim for Death Benefits LS-262 proposed.pdf www.dol.gov/esa/owcp/dlhwc/ls-262.pdf Form
LS-271 proposed Application for Self-Insurance LS-271 proposed.pdf www.dol.gov/esa/owcp/dlhwc/LS-271.pdf Form
LS-204 proposed Attending Physician's Supplementary Report ls-204 proposed.pdf www.dol.gov/esa/owcp/dlhwc/ls-204.pdf Form
LS-274 proposed Report of Injury Experience of Insurance Carrier or Self ls-274 proposed.pdf www.dol.gov/esa/owcp/dlhwc/LS-274.pdf Form
LS-200 proposed Report of Earnings ls-200 proposed.pdf www.dol.gov/esa/owcp/dlhwc/ls-200.pdf Form