|
View ESA-OWCP-DLHWC's Form 1215-0160 Online 
| Agency: |
ESA-OWCP-DLHWC |
| Title: |
DLHWC (Longshore) LS-274, Report of Injury Experience of Insurance Carrier or of Self-Insured Employer |
| Form Description: |
Insurance carriers and/or self-insured employers use this form to report their estimated reserves through a specified reporting period. The form is used by the National Office to determine the adequacy of the insurance carrier’s and/or self-insurer's security deposit. |
| OMB Control Number: |
1215-0160 |
| OMB Expiration Date: |
Monday, August 31, 2009
|
| |
|
