Request for Examination and/or Treatment

OMB 1240-0029

OMB 1240-0029

Form LS-1 is used by employers to authorize medical treatment for injured workers and by claimants to report findings of physical examinations and treatment recommended.

The latest form for Request for Examination and/or Treatment expires 2023-12-31 and can be found here.

OMB Details

Request for Examination and/or Treatment (Employer Burden)

Federal Enterprise Architecture: Income Security - General Retirement and Disability

Form LS-1Request for Examination and/or Treatmentwww.dol.gov/owcp/dlhwc/ls-1.pdfForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.


© 2024 OMB.report | Privacy Policy