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Application for Security Deposit Determination PrintResetU. S. Department of LibreOffice of Workers\' Compensation Programs OMB Form No. 12400005 Exp Date: 07/31/2023An insurance carrier authorized
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The DOL-ESA Form LS-276 is a document used to report and verify wage and employment information under the Longshore and Harbor Workers' Compensation Act.
Employers of employees covered under the Longshore and Harbor Workers' Compensation Act are required to file the DOL-ESA Form LS-276.
To fill out the DOL-ESA Form LS-276, employers must provide accurate information regarding employee wages, work hours, and nature of employment. Detailed instructions are typically available on the form itself or from the Department of Labor's website.
The purpose of the DOL-ESA Form LS-276 is to document employee wage information and employment details to assist in the determination of claims under the Longshore and Harbor Workers' Compensation Act.
The information that must be reported includes the employee's name, Social Security number, the number of hours worked, wages, and any other relevant employment details.
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