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

DOL Form LS-271

View ESA-OWCP-DLHWC's Form 1215-0160 Online htm
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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