U.S. Department of Labor Longshore Forms for DBA Claims
The following forms are the primary forms used by overseas contractors who have been injured while working for the United States government. Each form below serves a specific purpose in the DBA claims process. The LS-201 notifies your employer of your injury and must be submitted within 30 days of the incident. The OWCP-5a, 5b, and 5c are medical reporting forms completed by your treating physician to document your injury, treatment, and work capacity. All three are available in both English and Spanish. While we’ve made these forms available for your convenience, the DOL website is the best source for the most current versions, as forms are updated periodically and filing an outdated version can delay your claim.
- LS-201 – Notice of Employee’s Injury or Death
- OWCP-5a – Work Capacity Evaluation Psychiatric/Psychological Conditions (English)
- OWCP-5a – Evaluación de la capacidad de trabajo Condiciones psiquiátricas / psicológicas (Español)
- OWCP-5b – Work Capacity Evaluation Cardiovascular/Pulmonary Conditions (English)
- OWCP-5b – Evaluación de la capacidad de trabajo Condiciones cardiovasculares / pulmonares (Español)
- OWCP-5c – Work Capacity Evaluation for Musculoskeletal Conditions (English)
- OWCP-5c – Evaluación de la capacidad de trabajo Condiciones músculo esqueléticas (Español)