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2014 DoL LS-210-2026
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- Click ‘Get Form’ to open the 2014 DoL LS-210 in our platform.
- Begin by entering the OWCP No. and Carrier's No. in the designated fields at the top of the form.
- Fill in the name of the injured employee, including their first, middle initial, and last name.
- Provide the date of the accident using the format (Month, day, year) in section 4.
- Complete the address of the injured employee, ensuring all details are accurate.
- For sections regarding periods of disability, input dates for 'From' and 'Through' as well as any return-to-work dates.
- Indicate whether medical attention was received and provide necessary details if applicable.
- Finally, ensure that all required signatures are completed before saving or exporting your filled form.
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