(a) Any information required by the regulations in this part to be
submitted to OWCP must be submitted on forms the Director authorizes
from time to time for such purpose. Persons submitting forms may not
modify the forms or use substitute forms without OWCP's approval.
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Form No. Title
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(1) LS-271.......................... Application for Self-Insurance.
[[Page 915]]
(2) LS-274.......................... Report of Injury Experience.
(3) LS-275 SI....................... Self-Insurer's Agreement and
Undertaking.
(4) LS-275 IC....................... Insurance Carrier's Agreement and
Undertaking.
(5) LS-276.......................... Application for Security Deposit
Determination.
(6) LS-405.......................... Indemnity Bond.
(7) LS-570.......................... Card Report of Insurance.
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(b) Copies of the forms listed in this section are available for
public inspection at the Office of Workers' Compensation Programs,
Employment Standards Administration, U.S. Department of Labor,
Washington, D.C. 20210. They may also be obtained from OWCP district
offices and on the Internet at http://www.dol.gov/esa/owcp/dlhwc/
lsforms.htm.
