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Request for Examination and/or Treatment (Employee Burden)
Request for Examination and/or Treatment
OMB: 1240-0029
IC ID: 197372
OMB.report
DOL/OWCP
OMB 1240-0029
ICR 202309-1240-003
IC 197372
( )
Documents and Forms
Document Name
Document Type
Form LS-1
Request for Examination and/or Treatment (Employee Burden)
Form
LS-1 Request for Examination and/or Treatment
ls-1.pdf
www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-1.pdf
Form
DLHWC Seaportal.pdf
DLHWC SEA Portal
IC Document
Information Collection (IC) Details
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