Please rate Form Ls 203 Rev. Nov 2023
To file a claim for compensation benefits, complete and sign this form.
Within one year: except as noted below, a claim may be filed within one year after the injury or death.
Paid without an award: if compensation has been paid without an award, a claim may be filed within one year after the last payment.
Hearing loss: in case of hearing loss, a claim may be filed within one year after receipt by an employee of an audiogram.
New claim: if this is a new claim, and you do not have an OWCP Case Number, please submit the form through the SEAPortal (preferred method).
Social Security Number: disclosure of the claimant's Social Security Number (SSN) or tax identifying number (TIN) on this form is mandatory.
| Question | Answer |
|---|---|
| Form Name | LS-203 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 64 |
| Avg. time to fill out | 11 min |
| Edition | Nov 2023 |
| Issuing agency | Office of Workers' Compensation Programs |
| Who signs | The claimant or the person acting on their behalf |
| Other names | LS-203, LS203, LS 203, Employee's Claim for Compensation |
| Official source | LS-203 (Rev Nov 2023), Office of Workers' Compensation Programs |
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Please rate Form Ls 203 Rev. Nov 2023
