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E-mail This PageDOL Form LS-200
| Agency: | OWCP-DLHWC |
| Title: | DLHWC (Longshore) LS-200, Report of Earnings |
| Form Description: | DLHWC (Longshore) LS-200, Report of Earnings: This form is required and must be submitted by an employee who is being paid compensation by the Special Fund. The form reports all earnings from employment by the employee during the prior year or other specified period. |
| OMB Control Number: | 1240-0014 |
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