Application for Continuation of Death Benefit for Student

Application for Continuation of Death Benefit for Student

OMB: 1240-0026

IC ID: 13739

Documents and Forms

Document Name Document Type
Form LS-266 Application for Continuation of Death Benefit for Student Form and Instruction
LS-266 Application for Continuation of Death Benefit LS-266 Continuation of Death Benefit for Student.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-266.pdf Form and Instruction
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document