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November 5, 2008 DOL Home > Find It! By Form > DOL Form

DOL Form LS-210

Agency:	ESA-OWCP-DLHWC
Title:	DLHWC (Longshore) LS-210, Employer's Supplementary Report of Accident or Occupational Illness
Form Description:	DLHWC (Longshore) LS-210, Employer's Supplementary Report of Accident or Occupational Illness: The employer uses this form to notify the Department of Labor of changes to the initial injury report (LS-202) filed.
OMB Control Number:	1215-0031
OMB Expiration Date:	Friday, December 31, 2010