Agency:

OWCP

Title:

OWCP-1, Agreement and Undertaking DLHWC (Longshore) & DCMWC (Black Lung)

Form Description:

OWCP-1, Agreement and Undertaking: This form is an Agreement and undertaking for security in the payment of compensation benefits furnishing satisfactory proof to OWCP of the financial ability to pay such compensation benefits.

OMB Control Number:

1215-0034

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