Get Dol-esa Forms. Ls-267 - Dol

The DOL-ESA Form LS-267 is essential for individuals receiving death benefits under the U.S. Department of Labor's workers' compensation programs. This guide provides clear, step-by-step instructions on how to accurately complete the form online, ensuring that you submit the required information correctly and efficiently.

Follow the steps to fill out the DOL-ESA Form LS-267 online.

1. Press the ‘Get Form’ button to obtain the form and access it in the online editor.
2. Enter your Office of Workers' Compensation Programs (OWCP) number in the designated field.
3. Provide the carrier's number as instructed, ensuring that all details are accurate.
4. Type or print the name and address of the beneficiary clearly in the provided fields, including a telephone number for contact.
5. If you are a surviving spouse receiving death benefits, indicate your marital status by selecting 'Yes' or 'No' regarding whether you have remarried.
6. If payments are made on behalf of a beneficiary who is a student, confirm their enrollment status by selecting 'Yes' or 'No.' If 'Yes,' provide the name of the spouse and the date of marriage.
7. Affirm that you acknowledge receipt of compensation by signing in the designated area. Clearly print your name and the date of signing.
8. After completing the form, review all entries for accuracy. Finally, save the changes, and prepare to download, print, or share the completed form as needed.

Complete your DOL-ESA Form LS-267 online today to ensure you meet all requirements.