Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions

Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions

OMB: 1240-0005

IC ID: 13942

Documents and Forms

Document Name Document Type
Form LS-276 Securing Financial Obligations Under the Longshore and Harbor Workers' Compensation Act and its Extensions Form and Instruction
LS-276 Application for Security Deposit Determination LS-276.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-276.pdf Form and Instruction
LS-275 (SI) Agreement and Undertaking (Self-Insured Employer) LS-275si - 6-13-23.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-275si.pdf Form
LS-275 (IC) Agreement and Undertaking (Insurance Carrier) LS-275ic 6-13-2023.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/LS-275ic.pdf Form