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Click ‘Get Form’ to open it in the editor.
Begin by entering the OWCP No. and Carrier's No. in the designated fields at the top of the form.
Fill in the name and address of the employee or beneficiary, ensuring accuracy for effective communication.
Provide details about the employer, including their name and address, as well as critical dates such as the date of injury and when compensation payments began.
In section 11, clearly state the reasons for termination or suspension of payments to ensure compliance with reporting requirements.
Complete the payment sections by entering all relevant amounts paid for disability or death, ensuring you attach any continuation sheets if necessary.
Finally, have an authorized person sign and provide their title in boxes 18 and 19 before submitting your completed form.
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Industry Notice No-165 (Newly revised Form LS-208 (Notice of Payments) and the termination of Form LS-206 (Payment of Compensation Without Award)) PDF.Read more
Jul 31, 2019 This report was prepared under contract to the Department of Defense Strategic. Environmental Research and Development Program (SERDP).Read more
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