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May 8, 2009   
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DOL Form LS-271

View ESA-OWCP-DLHWC's Form LS-271 Online htm
Agency: ESA-OWCP-DLHWC
Title: DLHWC (Longshore) LS-271, Application for Self-Insurance
Form Description: DLHWC (Longshore) LS-271, Application for Self-Insurance: This report is required from any employer requesting authorization to become a self-insured employer under the Longshore Act and its extensions. No authorization will be approved unless a completed application form with the required supplemental documentation is received.
OMB Control Number: 1215-0160

 

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