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September 23, 2008 DOL Home > Find It! By Form > DOL Form

DOL Form LS-208

View ESA-OWCP-DLHWC's Form 1215-0024 Online htm

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Agency:	ESA-OWCP-DLHWC
Title:	DLHWC (Longshore) LS-208, Notice of Final Payment or Suspension of Compensation Payments
Form Description:	DLHWC (Longshore) LS-208, Notice of Final Payment or Suspension of Compensation Payments: This is a required form, submitted by the self-insured employer /insurance carrier to notify the Department of Labor and claimant that compensation benefits are being suspended. It shows the payment periods, the benefit rate and the total benefits paid. Failure to comply may result in a civil penalty.
OMB Control Number:	1215-0024
OMB Expiration Date:	Saturday, February 28, 2009