View ESA-OWCP-DLHWC's Form 1215-0160 Online
Agency: |
ESA-OWCP-DLHWC |
Title: |
DLHWC (Longshore) LS-271, Application for Self-Insurance |
Form Description: |
DLHWC (Longshore) LS-271, Application for Self-Insurance: This report is required from any employer requesting authorization to become a self-insured employer under the Longshore Act and its extensions. No authorization will be approved unless a completed application form with the required supplemental documentation is received. |
OMB Control Number: |
1215-0160 |
OMB Expiration Date: |
Monday, August 31, 2009
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