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November 4, 2008 DOL Home > Find It! By Form > DOL Form

DOL Form LS-205

Agency:	ESA-OWCP-DLHWC
Title:	DLHWC (Longshore) LS-205, Physician's Report on Impairment of Vision
Form Description:	DLHWC (Longshore) LS-205, Physician's Report on Impairment of Vision: In vision injuries, the treating physician uses this form to report their findings and diagnosis.
OMB Control Number:	1215-0031
OMB Expiration Date:	Friday, December 31, 2010