Get Dol Ls-203 2014-2025

The DoL LS-203 form is essential for individuals seeking compensation under various labor-related acts. This guide provides step-by-step instructions to help users navigate the online completion of the form effectively.

Follow the steps to successfully complete the DoL LS-203 online.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter the OWCP number if available, or leave it blank if this is a new claim.
3. Provide a contact telephone number where you can be reached.
4. Fill in the claimant's address, including the street number, city, state, and ZIP code.
5. Input the date of injury in the specified format (mm/dd/yyyy).
6. Select your marital status from the options provided.
7. Indicate your sex by selecting the appropriate option.
8. Enter your date of birth using the specified format.
9. Provide your Social Security number as it is required by law.
10. Detail the date and time of the accident in the specified format.
11. Note whether you stopped work immediately due to the injury.
12. Specify the date and hour when your pay stopped.
13. Record your wages or earnings at the time of the injury.
14. Answer whether you were doing regular work at the time of the injury.
15. Write down your occupation, including the job title.
16. Indicate the number of days you usually work per week.
17. Document the number of years you have worked for your employer.
18. Answer whether the injury caused you to lose time beyond the day or shift of the accident.
19. Detail the earliest date your supervisor or employer knew about the accident.
20. Provide exact details of where the accident occurred.
21. Describe how the accident happened in full, including any involved objects or substances.
22. Specify the nature of the injury, detailing the affected body part.
23. Indicate whether you have received medical attention for this injury.
24. Answer whether the treatment was provided by your choice of physician and if it was employer-provided.
25. Confirm your current disability status due to the injury.
26. State whether you have received any wages since becoming disabled.
27. Provide the name of your employer and their address.
28. Sign the form as the claimant or on behalf of the claimant.
29. Review your answers for accuracy and completeness before final submission.
30. Save the changes, and then download, print, or share the form as needed.

Complete your DoL LS-203 form online today for prompt compensation processing!