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Get Dol Ls-208 2018

Please be sure to include the OWCP Case Number. For further instructions please see the reverse side of this form. Form LS-208 Rev. May 2015 A claim may be filed within one year after the injury or death 33 U.S.C. Notice of Final Payment or Suspension of Compensation Payments Print U*S* Department of Labor Office of Workers Compensation Programs Reset INSTRUCTIONS This notice must be filed with the District Director at the address in 3 a within 16 days after compensation has been stopped or suspended* A copy of the completed form must be mailed to the claimant and the claimant s representative. Use of this form is mandatory. Failure to timely file this form shall result in assessment of a penalty as outlined in 20 CFR 702. 236. This form is to be used to report disability or death compensation payments as well as other statutory payments. The information will be used to verify the sufficiency of compensation paid under the Act. 3. Name and address of Employee or other beneficiary Type ....

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How to fill out the DoL LS-208 online

The DoL LS-208 form is essential for reporting compensation payments under various labor regulations. This guide will assist you in accurately completing this form online, ensuring that you meet all necessary requirements.

Follow the steps to complete the DoL LS-208 successfully.

  1. Click ‘Get Form’ button to obtain the form and access it in the online interface.
  2. Start filling out the form by entering the date of the accident or illness in the designated field.
  3. Input the claim number provided by the Office of Workers' Compensation Programs (OWCP).
  4. Enter the carrier’s number in the appropriate field to ensure proper identification.
  5. Provide the name of the injured worker along with the claimant's name if they are different.
  6. Fill in the claimant's address so that communication can be directed accurately.
  7. Indicate the type of compensation disability related to this claim.
  8. Document the average weekly wage by entering the relevant amount in the designated field.
  9. Provide the date the employee first lost time due to the injury. Specify the month, day, and year.
  10. Enter the compensation rate, making sure to note any applicable minimum or maximum rates that may apply.
  11. Indicate whether the employer continues to pay the injured person's salary and provide the necessary details.
  12. Complete the payment begin date information, specifying the month, day, and year it began.
  13. If applicable, provide the date the first check was issued and the date of the last payment made.
  14. Check the appropriate box for the type of notice you are submitting, indicating whether it is initial, interim, or final.
  15. List all payments made in the correct fields, detailing the type of disability, payment amounts, and the duration of those payments.
  16. Complete other necessary payment fields, including settlements, fees, or funeral expenses where applicable.
  17. Assign the employer's name and insurance carrier or self-insured employer, including their address, contact details, and signatures.
  18. Review all fields for accuracy. Once all information has been entered correctly, you can save your changes.

Start your online document management journey by completing your DoL LS-208 form now.

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Related content

U.S. Department of Labor - Office of Workers'...
May 26, 2015 ... Compensation) and LS-208 (Notice of Final Payment or Suspension of...
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