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View ESA-OWCP's Form 1215-0034 Online 
| Agency: |
ESA-OWCP |
| Title: |
OWCP-1, Agreement and Undertaking
DLHWC (Longshore) & DCMWC (Black Lung) |
| Form Description: |
OWCP-1, Agreement and Undertaking: This form is an Agreement and undertaking for security in the payment of compensation benefits furnishing satisfactory proof to OWCP of the financial ability to pay such compensation benefits. |
| OMB Control Number: |
1215-0034 |
| OMB Expiration Date: |
Wednesday, December 31, 2008
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