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  • May 15, 2026

How to Fill Out DOL Form LS-271 (w/Examples) + FAQs

You fill out DOL Form LS-271 by entering the deceased worker’s identifying information at the top, listing every surviving spouse, child, or other dependent in the relationship section, attaching certified proof of each relationship, and signing the statement under penalty of perjury before sending it to the OWCP district office handling the claim. The form is the sworn Statement as to Information Required in Support of Claim for Compensation by Surviving Spouse, Child, or Children used in death-benefit claims under the Longshore and Harbor Workers’ Compensation Act (LHWCA).

The problem this form solves is that the Division of Longshore and Harbor Workers’ Compensation cannot pay death benefits until it knows exactly who qualifies as a survivor, how each person was related, and whether anyone is barred by remarriage, age, or lack of dependency. The governing rules sit in 33 U.S.C. § 909 and the procedural regulations in 20 CFR Part 702, and the consequence of an incomplete LS-271 is a delay or outright denial of the weekly death benefit. Filing this form wrong can cost a widow thousands of dollars in retroactive payments and force a hearing before an Administrative Law Judge.

According to the DOL FY 2024 Longshore Annual Report, more than 27,000 lost-time injury cases and several hundred death claims move through OWCP each year, and dependency disputes are one of the top three reasons death benefits get held up at the district-director level.

Here is what you will learn:

  • 📝 How to complete every line of Form LS-271 without triggering a development letter
  • ⚖️ Which federal statutes and regulations control survivor eligibility and remarriage cutoffs
  • 👨‍👩‍👧 How to prove dependency for spouses, children, stepchildren, and posthumous kids
  • 🌊 How LS-271 interacts with Form LS-262, the DBA, and state workers’ comp
  • 🚫 The seven costliest mistakes that get death-benefit claims denied or reduced

What DOL Form LS-271 Actually Is

Form LS-271 is a sworn affidavit. It is not the claim itself. The actual death-benefit claim is filed on Form LS-262, and LS-271 is the supporting statement that locks in the survivor’s testimony about marriage, children, and dependency. The Office of Workers’ Compensation Programs uses the LS-271 to decide who shares the weekly death benefit and burial allowance under 33 U.S.C. § 909.

The form pulls its authority from the LHWCA, a 1927 federal statute that pays workers’ compensation to maritime workers injured on the navigable waters of the United States and adjoining piers, wharves, dry docks, terminals, and shipyards. Congress later extended the LHWCA to defense-base workers through the Defense Base Act, to outer-continental-shelf workers through the OCSLA, and to non-appropriated-fund employees through the NFIA. Survivors of every one of those workers use the same LS-271.

The plain-English explanation is that LS-271 forces the survivor to swear, in writing, who they are and how they were connected to the dead worker. The consequence of refusing or skipping a question is that the district director issues a development letter and freezes the file. A real-world example is Maria, a widow in San Pedro, who left the children section blank because the kids were grown and self-supporting; OWCP held her claim for 60 days while it confirmed no other dependents existed. A common misconception is that LS-271 replaces the marriage certificate, but the form requires a certified marriage record as an attachment.

Who Files the Form

Any person claiming death benefits must file an LS-271. That includes the surviving spouse, an adult child claiming continued benefits while in school, a parent or sibling claiming as a partial dependent, or a personal representative filing on behalf of a minor. Each claimant signs a separate LS-271 because the affidavit is personal and verifies that individual’s facts.

The consequence of letting one person sign for everyone is a fatal procedural defect under 20 CFR § 702.221. For example, James, an 18-year-old college freshman in Norfolk, must file his own LS-271 even though his mother already filed hers, because his student-status dependency must be sworn by him. Many people wrongly think a power of attorney lets one survivor sign for the rest, but OWCP rejects that approach.

Where the Form Lives

The blank PDF lives on the Longshore forms page maintained by the DLHWC. You can also request a paper copy from any of the twelve district offices, which cover regions from Boston to Honolulu. The form carries an OMB control number 1240-0013 and must be the current edition; older editions are routinely rejected.

The consequence of using a stale edition is that the claims examiner returns it unfiled, and the statute-of-limitations clock under 33 U.S.C. § 913 keeps running. Anita, a widow in Houston, lost three weeks of benefits because she printed a 2011 version off a third-party site. A common misconception is that any DOL form template is fine, but only the current OMB-approved LS-271 from dol.gov is accepted.

Step-by-Step: Filling Out LS-271 Line by Line

The form has six numbered sections. Each section ties to a specific eligibility test under 33 U.S.C. § 909 and 20 CFR § 702.151. Read every question twice, because answers are sworn under 18 U.S.C. § 1001, and a false answer is a federal felony.

Before you start, gather the deceased worker’s Social Security number, the OWCP case number (assigned after Form LS-201 or LS-202 is filed by the employer), certified marriage and birth records, school enrollment letters, and the death certificate.

Section 1: Deceased Employee Information

Enter the worker’s full legal name, date of birth, date of death, last home address, Social Security number, and employer at the time of injury or last exposure. Use the name exactly as it appears on the death certificate, because OWCP cross-checks against Social Security records. The “date of death” must match the certified death certificate to the day.

The consequence of a name mismatch is a development letter under 20 CFR § 702.336. A real example is Carlos Reyes-Mendoza, a shipyard welder whose widow wrote “Carlos Mendoza” on Line 1; OWCP held the file for 45 days. A common misconception is that nicknames are fine because the SSN matches, but the regulation requires legal-name precision.

Section 2: Claimant Identifying Information

This block captures the survivor’s full legal name, relationship to the deceased, date of birth, Social Security number, mailing address, and phone number. The relationship line is the most consequential field on the entire form, because it triggers the dependency presumption in 33 U.S.C. § 909(b).

If you are a spouse, write “surviving spouse.” If you are a child, write “natural child,” “adopted child,” “stepchild,” “acknowledged illegitimate child,” or “posthumous child.” Each label maps to a specific category in the statute, and the consequence of writing a vague term like “family” is loss of the conclusive presumption of dependency.

Section 3: Marriage Information

Spouses must list the date and place of the marriage, whether the marriage was ceremonial or common-law, and whether either party had any prior marriages. Common-law marriages are recognized only if valid under the law of the state where the couple lived, per Restatement (Second) Conflict of Laws § 283. Cohabiting partners with no valid marriage receive nothing under the LHWCA, although the 9th Circuit in Holmes v. Director, OWCP has acknowledged narrow estoppel exceptions.

The consequence of a defective marriage is total denial of the spousal share. Linda, who married a longshoreman in a non-licensed Las Vegas ceremony, was denied benefits because Nevada required a license. A common misconception is that a long cohabitation creates an automatic common-law marriage; only a handful of states still recognize new common-law marriages.

Section 4: Children and Other Dependents

List every child by name, date of birth, relationship, and current living arrangement. Include children from prior marriages, stepchildren actually living in the household, posthumous children, and acknowledged illegitimate children. Adult children aged 18 to 23 must show full-time student status to keep benefits flowing, per 33 U.S.C. § 902(14).

The plain-English rule is that a child under 18, or under 23 and in school, is conclusively presumed dependent. The consequence of leaving a child off the form is that they lose their statutory share, and OWCP will not retroactively reopen the apportionment without a Section 22 modification. For example, Tasha, a 20-year-old nursing student, was excluded because her stepmother forgot to list her; she had to file her own LS-271 and pursue modification.

Section 5: Prior Marriages and Remarriage

Disclose every prior marriage of the survivor and the deceased, with dates, places, and how each ended (death, divorce, annulment). The form also asks whether the survivor has remarried since the worker’s death, because remarriage of a surviving spouse triggers a two-year lump-sum payment and ends weekly compensation.

The consequence of hiding a remarriage is fraud liability under 18 U.S.C. § 1920 and forced repayment plus penalties. A real-world example is Diane, who concealed a 2024 remarriage in Florida; OWCP discovered it through a SAVE database cross-check and sought $48,000 in restitution. A common misconception is that an informal “religious-only” remarriage does not count, but courts treat it as remarriage if the new union is recognized in the state.

Section 6: Signature and Notarization

Sign and date the form. The instructions and 20 CFR § 702.151 require the signature be made under the LHWCA’s perjury provisions. Some district offices accept a self-attested signature, while others require a notary; call the assigned district office before mailing.

The consequence of an unsigned LS-271 is automatic rejection. Robert, a father claiming partial dependency on his deceased son, mailed an unsigned form and lost six weeks while the file sat. A common misconception is that an electronic signature on a printed PDF is enough; OWCP requires a wet ink signature unless filed through the SEAPortal e-filing system.

Three Real-World Scenarios

Scenarios show how the form behaves under pressure. Each table below reads left to right: the survivor’s choice, then the OWCP outcome.

Scenario 1: Widow With Two Minor Children

Survivor’s Action on LS-271 OWCP Outcome
Lists self as spouse with certified marriage record Spousal share approved at 50% of AWW
Lists both minor children with birth certificates Each child added at 16.66%, total apportioned to 83.33%
Caps benefits at the statutory maximum Family receives 66.66% of AWW capped at 200% of NAWW

Scenario 2: Defense Base Act Contractor Death Overseas

Survivor’s Action on LS-271 OWCP Outcome
Files LS-271 with DBA case number and Apostilled foreign marriage certificate Marriage validated under foreign-judgment principles
Discloses remarriage in country of residence Two-year lump sum triggered, weekly benefits end
Claims for child born after worker’s death Posthumous child added once paternity confirmed by DNA or hospital record

Scenario 3: Adult Student Child Filing Independently

Survivor’s Action on LS-271 OWCP Outcome
Files own LS-271 plus full-time enrollment letter Continued benefits approved through age 23
Drops below 12 credit hours mid-semester Benefits suspended under 20 CFR § 702.232
Re-enrolls full-time the next term Benefits reinstated retroactively to re-enrollment date

Named Examples That Illustrate the Rules

Priscilla Tran is the widow of a Long Beach crane operator killed in a 2025 dock collapse. She files LS-271 listing herself, her 6-year-old daughter, and her 19-year-old stepson who lives full-time in her home and attends Long Beach City College. OWCP approves all three because the stepson meets the living-in-household test under 33 U.S.C. § 902(14).

David Okafor is a Defense Base Act contractor’s adult brother in Lagos, Nigeria. He claims partial dependency because the worker sent him $400 a month. He files LS-271 with bank wire records and an Apostilled affidavit. OWCP grants partial-dependent status under 33 U.S.C. § 909(d), capped at the actual contributions.

Hannah Greenberg is the unmarried partner of a New Jersey shipyard worker. She files LS-271 claiming spousal benefits based on an eight-year cohabitation. OWCP denies the claim because New Jersey abolished common-law marriage in 1939, and the Benefits Review Board affirms the denial on appeal.

Mistakes to Avoid on LS-271

  • Leaving the OWCP case number blank, which causes the form to be misfiled and the Section 913 statute to keep running.
  • Forgetting to attach a certified marriage certificate, which forces a 20 CFR § 702.336 development letter and 30 days of delay.
  • Omitting a stepchild who lives in the home, which costs that child 16.66% of the average weekly wage until modified.
  • Hiding a remarriage, which triggers 18 U.S.C. § 1920 fraud exposure and disgorgement of paid benefits.
  • Listing a common-law marriage in a state that abolished it, which leads to outright denial of spousal benefits.
  • Using an outdated form edition, which causes outright rejection by the district director.
  • Signing without a notary in a district that demands one, which voids the affidavit and restarts the filing process.
  • Reporting an estimated date of death rather than the certified date, which creates a chain-of-evidence problem with the death certificate.
  • Failing to identify children from a prior marriage, which strips them of statutory shares under § 909(b).
  • Ignoring the dependency proof requirement for parents and siblings, which collapses partial-dependent claims.

Key Statutes, Regulations, and Cases

The plain-English explanation is that LS-271 sits inside a web of federal authority. The LHWCA at 33 U.S.C. §§ 901-950 creates the benefit. The implementing rules are in 20 CFR Part 702. The presumption of correctness for OWCP findings comes from 33 U.S.C. § 920.

The consequence of ignoring these authorities is procedural defeat at every level, from district director to ALJ to Benefits Review Board to the U.S. Court of Appeals. A real example is Director, OWCP v. Newport News Shipbuilding, 514 U.S. 122 (1995), where the Supreme Court limited who has standing to seek review of LHWCA awards. A common misconception is that state workers’ comp law fills gaps, but federal LHWCA is exclusive in covered cases.

Recap of Important Rulings

How LS-271 Interacts With Other Filings

LS-271 is one piece of a paperwork chain. The employer files Form LS-202 (Employer’s First Report of Injury) and Form LS-208 (Notice of Final Payment). The survivor files Form LS-262 (Claim for Death Benefits) and Form LS-271 together. If a hearing is needed, the parties move to the Office of Administrative Law Judges.

The plain-English flow is: employer reports the death, survivor claims benefits, survivor swears the LS-271 facts, OWCP investigates, OWCP issues a compensation order, and the carrier pays. The consequence of skipping LS-271 is that LS-262 cannot be adjudicated. Beatriz, a widow in Tampa, filed only LS-262 and waited four months before realizing OWCP needed the LS-271 too.

Defense Base Act Nuances

DBA claims use the same LS-271, but survivors often live abroad. Foreign documents must be Apostilled under the Hague Apostille Convention or authenticated through the local U.S. embassy. The consequence of unauthenticated documents is that OWCP cannot accept them.

A real example is Ahmed, the widow of a Kabul-based contractor, who sent a Dari-language marriage certificate without translation. OWCP held the file 90 days. A common misconception is that any English summary suffices, but the rule requires a certified translation by a qualified translator.

State Workers’ Comp Coordination

The LHWCA is exclusive for covered maritime workers. Yet some states like California, Louisiana, Texas, Virginia, and Washington sometimes assert concurrent jurisdiction, especially in the so-called “twilight zone” recognized in Sun Ship, Inc. v. Pennsylvania, 447 U.S. 715 (1980).

The consequence is that a survivor may file in both systems, but federal LS-271 controls the federal benefit. Yvette, a Louisiana widow, filed both state and LHWCA claims and used the LS-271 to lock in her federal share, then the state claim offset the federal. A common misconception is that double recovery is allowed; offsets prevent that.

Do’s and Don’ts

  • Do file LS-271 within one year of death under 33 U.S.C. § 913, because untimely claims are barred.
  • Do attach certified rather than photocopy records, because OWCP rejects uncertified copies under 20 CFR § 702.336.
  • Do file a separate LS-271 for every claimant, because each survivor swears their own facts.
  • Do keep a stamped copy, because the filing date controls the statute of limitations under § 913.

  • Do notify OWCP of any change in marital, school, or address status, because reporting duties continue under 20 CFR § 702.286.

  • Don’t use a notary stamp from outside the United States without Apostille, because foreign notarizations are not self-validating.

  • Don’t estimate dates, because 33 U.S.C. § 919 requires precision and the carrier will challenge guesses.
  • Don’t sign blank pages in advance, because each line must be true at signing.
  • Don’t rely on third-party form websites, because only the current DOL version is accepted.
  • Don’t ignore a development letter, because failure to respond results in dismissal under 20 CFR § 702.336.

Pros and Cons of Filing LS-271 Yourself

  • Pro: No legal fee, because the LHWCA caps attorney fees at OWCP-approved rates.
  • Pro: You control the timing and avoid statute-of-limitations risk under § 913.
  • Pro: You see every document the insurer sees, because OWCP serves all parties.
  • Pro: You build direct rapport with the district office claims examiner.

  • Pro: You can switch to counsel later, because § 928 shifts fees to the carrier when the insurer denies a claim.

  • Con: You may misclassify a stepchild’s status, which costs that child statutory shares.

  • Con: You may miss the § 913 one-year clock, which bars the claim forever.
  • Con: You may sign without understanding the perjury exposure under 18 U.S.C. § 1001.
  • Con: You may waive arguments by responding to a development letter incorrectly.
  • Con: You may underclaim partial dependency for parents and siblings, leaving money unclaimed under § 909(d).

Key Entities You Need to Know

The Office of Workers’ Compensation Programs administers the LHWCA through the Division of Longshore and Harbor Workers’ Compensation. The Office of Administrative Law Judges hears contested claims. The Benefits Review Board handles administrative appeals, and the U.S. Courts of Appeals take judicial review.

The plain-English breakdown is that OWCP is the front-line agency, ALJs are the trial judges, BRB is the appeals body, and federal circuit courts are the last stop before the Supreme Court. The consequence of confusing these forums is filing in the wrong place and missing a deadline. Marcus, a survivor in Seattle, filed his appeal directly with the Ninth Circuit and lost six months because the appeal had to start at the BRB.

Carriers and self-insured employers also play a role. They pay benefits, may controvert under Form LS-207, and may move for Section 8(f) Special Fund relief. A common misconception is that the carrier and OWCP are aligned; they are adverse parties in disputed cases.

State-Level Nuances Even Though LHWCA Is Federal

The federal LHWCA controls, but state law affects collateral issues. Marriage validity is a state-law question under each state’s Family Code. Probate, guardianship for minors, and conservatorship orders all come from state courts and may need to be attached to the LS-271.

The plain-English consequence is that a Texas guardianship order may be required before OWCP will pay benefits to a minor’s account. Sofia, a 9-year-old in Houston, could not receive direct deposit until her aunt obtained a Texas Estates Code Chapter 1104 guardianship. A common misconception is that OWCP will pay a minor directly; it will not without state-court authority.

States with heavy maritime industries, especially Louisiana, Texas, Washington, Virginia, California, and Mississippi, see overlapping LHWCA and state filings. The consequence is that a survivor may need to coordinate offsets and avoid double-recovery problems flagged in Sun Ship.

FAQs

Is DOL Form LS-271 mandatory for every death-benefit claim?

Yes. Every claimant under the LHWCA must file an LS-271 to verify identity, relationship, and dependency before OWCP pays death benefits to a surviving spouse, child, or other dependent.

Can I file LS-271 without a lawyer?

Yes. Survivors regularly file pro se, and the LHWCA fee-shifting rule lets you add counsel later if the carrier disputes the claim, often with the carrier paying the fee.

Do common-law spouses qualify under LS-271?

Yes, but only if the marriage is valid under the law of a state that recognizes common-law marriage at the date of formation, such as Colorado, Iowa, Kansas, Montana, Rhode Island, South Carolina, Texas, or the District of Columbia.

Does remarriage end my benefits?

Yes. A surviving spouse who remarries receives a two-year lump sum equal to two years of compensation under 33 U.S.C. § 909, and weekly benefits stop after that payment.

Are stepchildren eligible?

Yes, when the stepchild was a member of the deceased worker’s household at the time of injury or death, per 33 U.S.C. § 902(14) and confirmed by repeated Benefits Review Board rulings on household membership.

Do adult children get benefits?

Yes, if they are between 18 and 23 and are full-time students, or are physically or mentally incapable of self-support, under 33 U.S.C. § 902(14).

Is LS-271 used in Defense Base Act cases?

Yes. The DBA incorporates LHWCA procedure, so overseas-contractor survivors file the same LS-271, with foreign documents Apostilled under the Hague Convention.

Does the form need to be notarized?

Yes, in most district offices, although some accept self-attested signatures; always confirm with the assigned district office before mailing the form to avoid rejection.

Can I correct mistakes after filing?

Yes. Survivors may file an amended LS-271 or seek a Section 22 modification within one year of the last payment or denial, although the modification standard is strict.

Is there a deadline?

Yes. Under 33 U.S.C. § 913, survivors generally have one year from the date of death, or from the date the relationship to work was discovered for occupational disease, to file the death claim and supporting LS-271.

Will OWCP share my LS-271 with the employer?

Yes. All parties to a Longshore claim, including the employer and carrier, receive copies of every filed document under 20 CFR § 702.317, so expect the carrier to scrutinize every answer.

Do I need to update OWCP if my situation changes?

Yes. Reporting duties under 20 CFR § 702.286 continue, so changes in marital status, school enrollment, address, or dependency must be reported promptly to avoid overpayment recovery actions.

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