Certification of Funeral Expenses

Certification of Funeral Expenses under the Longshore and Harbor Workers' Compensation Act

OMB: 1240-0040

IC ID: 13646

Documents and Forms

Document Name Document Type
Form LS-265 Certification of Funeral Expenses Form
LS-265 Certification of Funeral Expenses LS-265.pdf www.dol.gov/sites/dolgov/files/owcp/dlhwc/ls-265.pdf Form
DLHWC Seaportal.pdf DLHWC SEA Portal IC Document