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View ESA-OWCP-DLHWC's Form 1215-0160 Online 
| Agency: |
ESA-OWCP-DLHWC |
| Title: |
DLHWC (Longshore) LS-200, Report of Earnings |
| Form Description: |
DLHWC (Longshore) LS-200, Report of Earnings: This form is required and must be submitted by an employee who is being paid compensation by the Special Fund. The form reports all earnings from employment by the employee during the prior year or other specified period. |
| OMB Control Number: |
1215-0160 |
| OMB Expiration Date: |
Monday, August 31, 2009
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