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

Administration of the Longshore and Harbor Workers' Compensation Act

OMB: 1240-0014

IC ID: 43808

Documents and Forms

Document Name Document Type
ESA 100.doc Other-Recordkeeping
LS-272instructions1.pdf www.dol.gov/owcp/dlhwc/LS-272instructions.pdf Instruction
LS-271instructions(1).pdf www.dol.gov/owcp/dlhwc/LS-271instructions.pdf Instruction
LS-200 Report of Earnings ls-200.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-200.pdf Form and Instruction
LS-201 Notice of Employee's Injury or Death ls-201 post-1-20-25 updated version.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-201.pdf Form and Instruction
LS-203 Employee's Claim for Compensation ls-203 post-1-20-25 updated version.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-203.pdf Form and Instruction
LS-204 Attending Physician's Supplementary Report ls-204.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-204.pdf Form and Instruction
LS-262 Claim for Death Benefits ls-262.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-262.pdf Form and Instruction
LS-267 Claimant's Statement LS-267.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-267.pdf Form and Instruction
LS-272 Application to write Longshore Insurance LS-272.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-272.pdf Form and Instruction
LS-274 Report of Injury Experience of Insurance Carrier or Self LS-274.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-274.pdf Form and Instruction
LS-271 Application for Self-Insurance LS-271.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-271.pdf Form and Instruction
LS-513 Report of Payments LS-513.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-513.pdf Form and Instruction
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document