View ESA-OWCP-DLHWC's Form 1215-0160 Online
Agency: |
ESA-OWCP-DLHWC |
Title: |
DLHWC (Longshore) LS-274, Report of Injury Experience of Insurance Carrier or of Self-Insured Employer |
Form Description: |
Insurance carriers and/or self-insured employers use this form to report their estimated reserves through a specified reporting period. The form is used by the National Office to determine the adequacy of the insurance carrier’s and/or self-insurer's security deposit. |
OMB Control Number: |
1215-0160 |
OMB Expiration Date: |
Monday, August 31, 2009
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