Report Of Earnings {LS-200}

LS-200 - REPORT OF EARNINGS. You are required to report on this form all earnings from employment or self- employment earned during the period specified on page 1 of this form (20 CFR 702.286). An employee who fails to report his/her earnings when requested or knowingly and willfully omits or understates any part of such earnings may forfeit his/her right to compensation with respect to any period during which this report is required. Compensation forfeited, if already paid, shall be deducted from any future compensation which may be due in accordance with a schedule determined by the District Director of the Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation, having jurisdiction in the case. (33 U.S.C. 908(j). Earnings are defined as all monies received from any employment and includes but is not limited to wages, salaries, tips, sales commissions, fees for services provided, piecework and all revenue received from self- employment even if the business or enterprise operated at a loss or if the profits were reinvested. An employer, insurance carrier, or the Director of the Office of Workers' Compensation Programs, Division of Federal Employees', Longshore and Harbor Workers' Compensation (for those cases being paid from the Special Fund) may require an employee to file this report semiannually. The information provided will be used to determine entitlement to benefits. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. www.FormsWorkflow.com