Get Dol Ls-208 2021-2025

The DoL LS-208 is a crucial form required under the Longshore and Harbor Workers' Compensation Act, designed to report compensation payments made for injuries. This guide provides step-by-step instructions on how to accurately fill out this form online, ensuring all necessary information is captured correctly.

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

1. Click 'Get Form' button to obtain the LS-208 form and open it for completion.
2. Begin by entering the date of the accident or illness in field 1. Ensure the format is month, day, and year.
3. Input the carrier's number in field 2, followed by the Office of Workers' Compensation Programs (OWCP) number in field 3.
4. In field 4, provide the names of the injured worker and the claimant if they are different.
5. Enter the claimant's address in field 5. This should include the street address, city, state, and zip code.
6. Indicate the type of compensation disability in field 6 and the average weekly wage in field 8.
7. Record the date the employee first lost time due to the injury in field 7.
8. Document the compensation rate in field 9 and the payment begin date in field 10.
9. Check 'Yes' or 'No' in field 10 regarding whether the employer continues to pay the injured person's salary.
10. If applicable, indicate the reason for any differences in dates in the comments section provided.
11. In field 11, enter the date of the first check ever issued on this claim.
12. Select the type of notice being submitted in field 12 by checking either 'Initial', 'Interim', or 'Final'.
13. Complete fields 13 and 14 with reasons for interim payments, final payments, and indicate the date of the last payment made.
14. Detail all payments made on account of disability in fields 15a-f, including the type of disability, payment dates, and amounts.
15. Enter other payments in section 16, detailing any relevant settlements, fees, or expenses.
16. Fill in employer and insurance carrier information in fields 17 and 18, including their addresses and contact details.
17. Ensure the form is signed and dated in the final fields by the authorized person.
18. Once all information is verified, save your changes, and download or print the completed form for submission.

Complete your DoL LS-208 form online today for efficient processing of compensation payments.