2014 DoL LS-210-2026

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

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