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View ESA-OWCP-DLHWC's Form 1215-0160 Online 
| Agency: |
ESA-OWCP-DLHWC |
| Title: |
DLHWC (Longshore) LS-262, Claim for Death Benefits |
| Form Description: |
DLHWC (Longshore) LS-262, Claim for Death Benefits: This form is used to claim death benefits under the Longshore Act or its extensions. The form is submitted by or on behalf of each person claiming to be eligible for death benefits. Information on the form is used to assist in determining entitlement to death benefits. The filing of this form does not automatically guarantee entitlement to death benefits. |
| OMB Control Number: |
1215-0160 |
| OMB Expiration Date: |
Monday, August 31, 2009
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