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E-mail This PageDOL Form LS-271
| Agency: | 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: | 1240-0014 |
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