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This version of the form is not currently in use and is provided for reference only. Download this version of
Form LS-262
for the current year.
Form LS-262 Claim for Death Benefits
What Is Form LS-262?
This is a legal form that was released by the U.S. Department of Labor - Office of Workers' Compensation Programs on April 1, 2012 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form LS-262?A: Form LS-262 is a claim form for death benefits.
Q: Who can use Form LS-262?A: Form LS-262 can be used by beneficiaries of deceased employees.
Q: What are death benefits?A: Death benefits are benefits payable to the survivors or dependents of a deceased employee.
Q: What information is required in Form LS-262?A: Form LS-262 requires information about the deceased employee, the claimant, and the relationship between them.
Form Details:
- Released on April 1, 2012;
- The latest available edition released by the U.S. Department of Labor - Office of Workers' Compensation Programs;
- Easy to use and ready to print;
- Yours to fill out and keep for your records;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of Form LS-262 by clicking the link below or browse more documents and templates provided by the U.S. Department of Labor - Office of Workers' Compensation Programs.
Download Form LS-262 Claim for Death Benefits
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