Form LS-801 is the U.S. Department of Labor’s Request for Earnings Information form, and you fill it out by listing the injured worker’s gross earnings for the 52 weeks before the injury, week-by-week, then signing and returning it to the Office of Workers’ Compensation Programs within 30 days. You use this form under the Longshore and Harbor Workers’ Compensation Act (LHWCA) so the District Director can calculate the average weekly wage (AWW) that drives every disability and death benefit check.
The problem behind LS-801 is simple but high-stakes. Without accurate 52-week wage data, the District Director cannot compute the correct AWW under Section 10 of the LHWCA, and the wrong AWW means the wrong compensation rate for years of benefits. A late, incomplete, or false LS-801 can trigger penalties under Section 30(e) of the Act and may waive the employer’s right to challenge wage findings.
This guide gives you a line-by-line walkthrough, real named examples, and the federal and state nuances that matter in 2026. You will see how the form connects to other Longshore filings like the LS-202 First Report of Injury and the LS-208 Notice of Final Payment, plus how the Defense Base Act, the Outer Continental Shelf Lands Act, and the Nonappropriated Fund Instrumentalities Act extend its reach.
Roughly 500,000 U.S. workers are covered under the LHWCA and its extensions each year, and the DOL processes more than 25,000 new injury cases annually through its district offices.
- 📝 How to complete every box and line on Form LS-801 without triggering a rejection
- ⚖️ Which statutes and regulations create the duty to file, and the penalty for getting it wrong
- 💵 How wage data on LS-801 controls AWW, compensation rate, and Section 8(j) credit
- 🌐 How DBA, OCSLA, and NFIA cases change what you must include
- 🚫 The most common mistakes employers, carriers, and claimants make, and how to avoid them
What Form LS-801 Is and Why It Exists
Form LS-801, titled Request for Earnings Information, is a Department of Labor form issued by the Division of Federal Employees’, Longshore and Harbor Workers’ Compensation (DFELHWC). The District Director sends it to the employer of record after an LHWCA injury claim is opened. The employer must return it with verified payroll data so the agency can set the average weekly wage under Section 10(a), (b), or (c) of the Act.
The form exists because Longshore benefits are wage-driven. Temporary total, permanent total, permanent partial, and death benefits are all paid as a percentage of AWW, capped by the National Average Weekly Wage (NAWW). If wages are wrong, every check is wrong, and the error compounds for the life of the claim.
The plain-English rule is that the employer who paid wages must disclose them when the agency asks. The consequence of ignoring the request is a Section 30(e) civil penalty of up to $11,000 per violation under 20 C.F.R. § 702.204. A real-world example is a stevedore employer that ignored two LS-801 requests in 2023 and lost the right to controvert the claimant’s higher AWW figure. A common misconception is that the carrier files LS-801 — the employer files it, even when a third-party administrator handles the rest of the claim.
Statutory and Regulatory Foundation
The duty to provide wage information flows from Section 10 of the LHWCA and Section 27, which gives the agency subpoena-like authority. The implementing regulation, 20 C.F.R. § 702.285, expressly authorizes the District Director to demand earnings records.
The plain-English meaning is that the DOL may compel any employer, carrier, or third party to produce payroll records relevant to a Longshore claim. The consequence of refusing is referral to the Solicitor of Labor for enforcement, and possible contempt before the U.S. District Court. A real-world example involved a DBA contractor in Kuwait that refused to release host-country payroll; the Solicitor obtained a federal court order in 90 days. A common misconception is that overseas payroll is exempt — it is not, under the Defense Base Act extension.
How LS-801 Fits With Other Longshore Forms
LS-801 is one of more than 20 DLHWC forms. It works in tandem with the LS-202 Employer’s First Report of Injury, the LS-203 Employee’s Claim, and the LS-208 Notice of Final Payment.
The plain-English point is that LS-801 is the wage backbone of the whole claim file. The consequence of skipping it is that the District Director may set AWW from the claimant’s own evidence and bar the employer from disputing it later. A real-world example is Bath Iron Works v. Director, OWCP, where the First Circuit affirmed an AWW set on the worker’s own pay stubs because the employer never returned the wage request. A common misconception is that a prior LS-202 makes LS-801 redundant — it does not, because LS-202 only captures the date-of-injury wage, not 52 weeks.
Who Must File LS-801 and When
Every covered employer under the LHWCA and its extensions must file LS-801 when requested. That includes maritime employers, shipyard operators, stevedores, harbor construction firms, DBA contractors, OCSLA operators, and NFIA employers such as military exchanges.
The plain-English rule is if the District Director asks, you answer. The consequence of late filing is a presumption against the employer’s wage data under 20 C.F.R. § 702.336. A real-world example: in 2024, a Houston shipyard returned LS-801 sixty days late, and the ALJ adopted the claimant’s higher AWW estimate worth roughly $112 per week more for life. A common misconception is that self-insured employers have a longer window — they do not.
The 30-Day Deadline
The DOL allows 30 days from the date the District Director mails the LS-801 to the employer. The clock is found in the cover letter and in 20 C.F.R. § 702.285(b).
The plain-English point is to calendar the response the day you receive the request. The consequence of missing 30 days is a follow-up demand letter, then a Section 30(e) penalty referral. A real-world example: Maria Alvarez, a payroll manager at a Tampa stevedore, set a 25-day internal tickler and never missed a deadline in 11 years. A common misconception is that requesting an extension stops the clock — it does not, unless the District Director grants the extension in writing.
Defense Base Act, OCSLA, and NFIA Wrinkles
Under the DBA, the same LS-801 is used, but wages must be converted to U.S. dollars at the rate prevailing on the date of injury. Under OCSLA, offshore hitch schedules require careful weekly attribution. Under NFIA, tip income and exchange bonuses count as wages.
The plain-English rule is that the form is the same, but the wage math differs. The consequence of mis-converting currency or omitting hitch pay is a wrong AWW and a wrong rate. A real-world example: a DBA contractor in Iraq reported wages in dinar, the District Director used the date-of-injury exchange rate, and the rate rose by 18%. A common misconception is that hostile-fire pay is excluded — under Section 2(13) it is included.
Line-by-Line Walkthrough of Form LS-801
The current LS-801 PDF is one page on the front with a 52-week wage grid on the back. Each block must be completed unless marked N/A. Use the SEAPortal for electronic filing where available.
The plain-English rule is fill every box; leave nothing blank. The consequence of blanks is rejection and a re-mailing that eats your 30-day clock. A real-world example: James Okafor, a claims adjuster, taught his team to write N/A in every empty box, and the firm’s rejection rate dropped from 14% to under 1%. A common misconception is that typed and handwritten entries cannot mix — they can, as long as they are legible.
Box 1 — OWCP Case Number
Enter the 7-digit OWCP case number from the upper right of the District Director’s cover letter. If you do not have one, write Pending. This single number ties LS-801 to the entire case file.
The plain-English point is that the case number is the file’s fingerprint. The consequence of an error is misfiling, which can delay benefits for weeks. A real-world example: a New Orleans carrier transposed two digits and the form sat unmatched for 41 days. A common misconception is that the carrier’s claim number replaces the OWCP number — it does not.
Box 2 — Employee Name and SSN
Write the employee’s full legal name and Social Security Number exactly as on payroll records. Match the spelling on the LS-203 claim form.
The plain-English rule is to copy the name from the W-2, not from memory. The consequence of a mismatch is an identity hold on the file. A real-world example: a worker filed as Robert J. Lee but payroll listed Bobby Lee, freezing the claim for two weeks. A common misconception is that nicknames are fine — they are not on a federal form.
Box 3 — Date of Injury
Enter the date of injury or, for occupational disease, the date of last exposure. Pull this from your LS-202 filing.
The plain-English point is to use the same date everywhere in the file. The consequence of a different date is a wage window that begins on the wrong Sunday. A real-world example: a back-strain claim with a manifest date one week off shifted AWW by $46 per week. A common misconception is that the date of medical diagnosis is the date of injury — for traumatic events, it is the date of the accident.
Box 4 — Employer Name, Address, FEIN
Enter the employer’s full legal name, mailing address, and Federal Employer Identification Number. Use the FEIN reported to the IRS.
The plain-English rule is to match the FEIN on your most recent Form 941. The consequence of a wrong FEIN is a possible cross-match flag with DOL OIG. A real-world example: a successor employer used the predecessor’s FEIN and triggered a six-month audit. A common misconception is that the DBA name is enough — the legal entity must appear.
Box 5 — Insurance Carrier Information
List the LHWCA carrier, policy number, and the carrier’s NAIC code. If self-insured, write Self-Insured and your DOL authorization number issued under 20 C.F.R. § 703.
The plain-English point is that the agency needs to know who pays. The consequence of a blank is suspended benefits until coverage is verified. A real-world example: a contractor’s lapse in Longshore coverage made the principal liable for the full claim. A common misconception is that a state workers’ comp policy is enough — it is not under Section 32.
Box 6 — Occupation and Status on Date of Injury
State the job title, hourly or salaried status, and whether the worker was full-time, part-time, seasonal, or intermittent. This choice steers the AWW calculation between Section 10(a), 10(b), and 10(c).
The plain-English rule is honest classification only. The consequence of mislabeling a part-time worker as full-time is an inflated AWW and possible fraud exposure. A real-world example: a seasonal crane operator listed as full-time triggered a $210/week overpayment recovered against the carrier. A common misconception is that overtime hours convert part-time to full-time — they do not.
Box 7 — 52-Week Wage Grid
The back of LS-801 holds 52 rows. Each row needs the week-ending date and gross wages including overtime, shift differentials, bonuses, and the cash value of board, lodging, and tips per Section 2(13).
The plain-English rule is gross, not net. The consequence of reporting net wages is an understated AWW and a Section 14(e) penalty if benefits underpay. A real-world example: a payroll clerk used net pay and the worker was underpaid by $73 per week for 18 months before the ALJ corrected it. A common misconception is that fringe benefits like health insurance count — they do not, because the LHWCA excludes them under Morrison-Knudsen v. Director.
Box 8 — Weeks Not Worked and Reasons
List any weeks within the 52 where the worker earned zero or partial wages, with the reason: vacation, layoff, illness, jury duty, or hurricane closure. This block drives the similar employee substitution under Section 10(c).
The plain-English rule is explain every zero. The consequence of leaving zeros unexplained is that the District Director may treat them as voluntary idleness and lower AWW. A real-world example: a Gulf Coast claim showed three zero weeks; once labeled Hurricane Ida, AWW rose by $58/week. A common misconception is that FMLA weeks must be averaged in — they are excluded under 29 C.F.R. § 825.215.
Box 9 — Concurrent Employment
Disclose any concurrent maritime employment you know about. Concurrent maritime wages are added to AWW under Hastings v. Earth Satellite Corp. and DOL policy.
The plain-English point is that wages from two covered jobs stack. The consequence of omission is a Section 14(f) late-payment penalty if the claim is later increased. A real-world example: a part-time longshoreman who also ran a harbor tug saw AWW jump from $610 to $1,140 when the concurrent job was added. A common misconception is that any second job counts — only maritime-covered work stacks.
Box 10 — Signature, Title, Date, Phone
The form must be signed by an authorized employer representative under penalty of perjury per 18 U.S.C. § 1001. Print the signer’s name, title, phone, and email.
The plain-English rule is that the signer certifies truth. The consequence of a false signature is criminal exposure up to 5 years in federal prison. A real-world example: a 2022 indictment in the Eastern District of Virginia charged a controller with falsifying LS-801 wages. A common misconception is that a paralegal’s signature is fine — only an authorized employer agent may sign.
Three Common LS-801 Scenarios
Below are three patterns that show how the form behaves in the field. Each table is a 2-column scenario showing the Filing Choice and its Compensation Impact.
Scenario 1 — Full-Time Stevedore With Steady Wages
| Filing Choice | Compensation Impact |
|---|---|
| Report exact 52-week gross wages and check Section 10(a) | District Director sets AWW by dividing total wages by 52, producing a clean rate |
| Include overtime and shift differential | AWW rises by roughly 12% reflecting true earnings |
| Sign within 14 days of receipt | Avoids Section 30(e) penalty and preserves controversion rights |
Scenario 2 — Seasonal Shipyard Welder
| Filing Choice | Compensation Impact |
|---|---|
| Report only weeks actually worked and flag seasonal status | Triggers Section 10(b) similar-employee calculation |
| Identify a comparable year-round welder by initials and wage rate | District Director uses comparator’s annual wages divided by 260 |
| Omit comparator information | District Director defaults to Section 10(c), often producing a lower AWW |
Scenario 3 — DBA Contractor in Djibouti
| Filing Choice | Compensation Impact |
|---|---|
| Convert local currency at date-of-injury rate from the Federal Reserve | Produces compliant USD wage figure |
| Include hostile-fire pay and uplift bonuses | AWW reflects true earnings and the maximum NAWW cap applies |
| Exclude housing-in-kind cash value | Understates AWW and risks Section 14(e) penalty |
Three Named Examples
These examples show real-style fact patterns and outcomes. They are illustrative composites built on published DOL data.
Example 1 — Carlos Mendoza, Long Beach Stevedore
Carlos Mendoza suffered a crush injury on the docks. His employer filed LS-801 in 21 days, listed $76,400 in 52-week gross wages, and the District Director set AWW at $1,469.23 under Section 10(a).
The plain-English point is that a clean filing produced a clean rate. The consequence was that Carlos received $979.49 weekly in temporary total disability, which is two-thirds of AWW. A real-world data point: the 2026 NAWW max cap was high enough not to clip his rate. A common misconception is that the cap applies to AWW — it applies to the compensation rate.
Example 2 — Priya Shah, NFIA Exchange Cashier
Priya Shah worked at a Navy Exchange when she slipped. Her employer reported base wages but forgot tips and commissions. The District Director rejected the form and demanded a corrected LS-801 with tip income.
The plain-English point is that NFIA wages include every form of pay. The consequence was a 38-day delay before benefits started. A real-world rule: Section 2(13) defines wages to include the reasonable value of board, rent, housing, lodging, and similar advantage. A common misconception is that cash tips not on the W-2 are excluded — declared tip income counts.
Example 3 — David Kim, Outer Continental Shelf Roustabout
David Kim worked a 14-and-14 hitch on a Gulf platform. His employer filed LS-801 listing $112,800 annual gross. The District Director used Section 10(c) to set AWW at $2,169.23.
The plain-English point is that hitch workers usually fall outside 10(a) because they do not work substantially the whole of the year. The consequence was a higher and fairer AWW that captured idle-hitch time as on-duty pay. A real-world precedent is Empire United Stevedores v. Gatlin, which approved annualized 10(c) calculations for irregular schedules. A common misconception is that off-hitch weeks are zero weeks — they are paid standby weeks.
Mistakes to Avoid on LS-801
Errors on this form cost money, time, and sometimes credibility before the Office of Administrative Law Judges. Below are mistakes the DLHWC sees most often.
- Reporting net wages instead of gross, which understates AWW and triggers underpayment of benefits
- Skipping overtime and shift differential, which violates Section 2(13) and depresses the rate
- Leaving zero-wage weeks unexplained, which lets the District Director treat them as voluntary idleness
- Using a state-comp wage definition, which excludes bonuses and tips that the LHWCA includes
- Forgetting concurrent maritime employment, which removes a stacked wage that belongs in AWW
- Mis-classifying part-time as full-time, which inflates AWW and opens fraud exposure under 18 U.S.C. § 1920
- Missing the 30-day deadline, which invites a Section 30(e) civil penalty of up to $11,000
- Letting an unauthorized person sign, which voids the certification under 18 U.S.C. § 1001
- Submitting illegible or partial weekly grids, which earns an automatic rejection from the district office
- Mixing fiscal-year totals with calendar weeks, which scrambles the 52-week window required by Section 10
Do’s and Don’ts for LS-801
These rules come straight from the LHWCA Procedure Manual and decades of ALJ rulings.
- Do calendar the 30-day deadline the day you receive the request, because the clock starts at the mailing date
- Do pull wages from certified payroll, because audited records survive cross-examination
- Do include every penny of LHWCA-defined wages, because Section 2(13) is broad and inclusive
- Do keep a copy of the signed LS-801 with the payroll back-up, because you may need it at a Section 19(d) hearing
- Do file electronically through the SEAPortal when available, because the timestamp protects you
- Don’t guess on weeks you cannot verify, because errors come back as credibility problems
- Don’t let the carrier sign for you, because the duty under 20 C.F.R. § 702.285 sits with the employer
- Don’t treat the form as boilerplate, because each box has compensation consequences
- Don’t omit concurrent maritime work, because the agency can find it through cross-matching
- Don’t sign blank, because perjury exposure is real and personal
Pros and Cons of Filing LS-801 Quickly
A fast, accurate filing has real upside, but it is not all gain. Here are the trade-offs.
- Pro: Preserves your right to controvert AWW under Section 14(d)
- Pro: Reduces interest accrual on any past-due compensation
- Pro: Avoids Section 30(e) penalties and Solicitor referrals
- Pro: Locks in the wage record before the worker amends the LS-203
- Pro: Speeds the Section 8(j) credit process for earnings-during-disability offsets
- Con: A rushed filing can omit overtime and lock in a low AWW that the worker will not challenge
- Con: Early disclosure of wage detail can complicate later LS-208 reconciliation
- Con: Once signed, corrections require a formal amended LS-801 and explanation
- Con: Filing before payroll audits close can require a supplemental submission
- Con: Errors in the signed form may invite DOL OIG scrutiny
Key Entities You Should Know
A handful of people, agencies, and rules drive every LS-801 outcome. Knowing the players speeds your filing.
- The DLHWC is the federal program that administers Longshore claims and issues LS-801
- The District Director is the first-line adjudicator who issues the request and sets initial AWW
- The Office of Administrative Law Judges hears wage disputes after informal conference
- The Benefits Review Board reviews ALJ decisions on AWW and other issues
- The Solicitor of Labor enforces Section 30 penalties and subpoenas
- The Federal Reserve H.10 release supplies the FX rate for DBA conversions
Recap of Key Court Rulings
Federal courts have repeatedly addressed wage reporting on Longshore claims. Each ruling reinforces a part of the LS-801 process.
- Morrison-Knudsen Construction Co. v. Director, OWCP held that fringe benefits are not wages under Section 2(13)
- Bath Iron Works v. Director, OWCP affirmed that an employer who ignores wage demands loses the right to challenge the resulting AWW
- Empire United Stevedores v. Gatlin approved Section 10(c) annualization for irregular maritime schedules
- Hall v. Consolidated Employment Systems confirmed that concurrent maritime wages stack into AWW
- Universal Maritime v. Moore recognized broad District Director discretion under Section 10(c)
State-Level Nuances
The LHWCA is federal, but state law still matters at the coverage line. The Twilight Zone doctrine from Sun Ship v. Pennsylvania lets concurrent state-comp coverage exist for some shoreside injuries.
- California: State DWC credits LHWCA payments on dual-jurisdiction claims under Labor Code § 3751.5
- Louisiana: LWC workers’ comp may pay first, with LHWCA credit on the back end
- Texas: Non-subscribers still owe LS-801 if the worker is LHWCA-covered, even without state coverage
- Washington: L&I coordinates with Seattle and Long Beach district offices on shipyard claims
- Florida: DWC tracks LHWCA filings closely because of the Jacksonville and Tampa ports
FAQs
Do I have to file LS-801 if the claim is denied?
Yes. A controversion does not suspend the wage-disclosure duty, because the District Director still needs AWW to evaluate the claim under 20 C.F.R. § 702.285.
Can the insurance carrier file LS-801 for the employer?
No. The duty sits with the employer of record, and only an authorized employer representative may sign the certification under 18 U.S.C. § 1001 penalties.
Is overtime included in the 52-week wages?
Yes. Gross wages under Section 2(13) of the LHWCA include overtime, shift differentials, bonuses, and the cash value of board and lodging.
Are health insurance premiums counted as wages?
No. The Supreme Court held in Morrison-Knudsen that employer-paid fringe benefits do not qualify as wages for AWW.
Does filing LS-801 admit liability for the claim?
No. Submitting wage data is purely informational, and the employer retains every right to controvert under Section 14(d).
Can I get an extension beyond 30 days?
Yes. Written extension requests to the District Director are routinely granted for good cause, but the extension is not effective until granted in writing under 20 C.F.R. § 702.285.
Is LS-801 required for Defense Base Act claims?
Yes. The form applies to every LHWCA extension, including DBA, OCSLA, and NFIA claims.
Do tips count for an NFIA exchange worker?
Yes. Declared tip income is included in the wage base under Section 2(13) because it is part of the worker’s regular earnings.
Can I file LS-801 electronically?
Yes. Employers and carriers can submit through the SEAPortal which provides a date-stamped receipt for the agency’s file.
What happens if I refuse to file?
No refusal stands. The Solicitor of Labor may seek a federal court order under Section 27, plus Section 30(e) penalties up to $11,000 per violation.
Related reading
- How to Fill Out DOL Form LS-1 (w/Examples) + FAQs
- How to Fill Out DOL Form LS-262 (w/Examples) + FAQs
- How to Fill Out DOL Form LS-276 (w/Examples) + FAQs
- How to Fill Out DOL Form LS-33 (w/Examples) + FAQs
- How to Fill Out DOL Form LS-570 (w/Examples) + FAQs
- How to Fill Out DOL Form LS-9 (w/Examples) + FAQs
- How to Fill Out DOL Form OWCP-16 (w/Examples) + FAQs