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

DOL Form LS-206

View ESA-OWCP-DLHWC's Form 1215-0022 Online htm
Agency: ESA-OWCP-DLHWC
Title: DLHWC (Longshore) LS-206, Payment of Compensation Without Award
Form Description: DLHWC (Longshore) LS-206, Payment of Compensation Without Award: This is a required form, submitted by the self-insured employer or insurance carrier to notify the Department of Labor that they have begun payment of workers' compensation benefits to an injured worker. It includes the date benefits begin, the average weekly wage and the compensation rate at which benefits are being paid.
OMB Control Number: 1215-0022
OMB Expiration Date: Wednesday, December 31, 2008




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