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Get DoL LS-208 2011

Istrict Director within 16 days after compensation has been stopped or suspended. Use of this form is mandatory. Failure to timely file this form shall result in assessment of a penalty of $110.00. (33 U.S.C. 914(g)). 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 or print) 1. OW.

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