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E-mail This PageDOL Form LS-274
| Agency: | OWCP-DLHWC |
| Title: | DLHWC (Longshore) LS-274, Report of Injury Experience of Insurance Carrier or of Self-Insured Employer |
| Form Description: | Insurance carriers and/or self-insured employers use this form to report their estimated reserves through a specified reporting period. The form is used by the National Office to determine the adequacy of the insurance carrier’s and/or self-insurer's security deposit. |
| OMB Control Number: | 1240-0014 |
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