View ESA-OWCP-DLHWC's Form 1215-0022 Online
Agency: |
ESA-OWCP-DLHWC |
Title: |
DLHWC (Longshore) LS-206, Payment of Compensation Without Award |
Form Description: |
DLHWC (Longshore) LS-206, Payment of Compensation Without Award: This is a required form, submitted by the self-insured employer or insurance carrier to notify the Department of Labor that they have begun payment of workers' compensation benefits to an injured worker. It includes the date benefits begin, the average weekly wage and the compensation rate at which benefits are being paid. |
OMB Control Number: |
1215-0022 |
OMB Expiration Date: |
Wednesday, December 31, 2008
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