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May 8, 2009   
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DOL Form LS-208

View ESA-OWCP-DLHWC's Form LS-208 Online htm
Agency: ESA-OWCP-DLHWC
Title: DLHWC (Longshore) LS-208, Notice of Final Payment or Suspension of Compensation Payments
Form Description: DLHWC (Longshore) LS-208, Notice of Final Payment or Suspension of Compensation Payments: This is a required form, submitted by the self-insured employer /insurance carrier to notify the Department of Labor and claimant that compensation benefits are being suspended. It shows the payment periods, the benefit rate and the total benefits paid. Failure to comply may result in a civil penalty.
OMB Control Number: 1215-0024

 

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