Web027 Occupational Disease Claim. – Form Instructions. 113a Summary of Medical Record – Industrial Accident. (or you may submit actual medical records supporting your claim) 113b Summary of Medical Record – Occupational Exposure. (or you may submit actual medical records supporting your claim) 152 Appointment of Counsel. (optional) WebForm C-26 Notice of Change or Termination of Benefits Workers' Compensation: LB-0285: PDF: Form C-30a Final Medical Report: Workers' Compensation: LB-0383: PDF: Form …

Workers

WebDistricts may create their own standardized form (Waiver Application) using established criteria as outlined in the Rule 61L-2.007(3): School Status; Financial Hardship; Medical … feminist hat

Overpayment and Waiver Request Information - Georgia …

WebAnnual Tax and Wage Report For Domestic Employment - DOL 4A (225.15 KB) Annual tax and wage report which domestic employers must file. The annual report and any … WebThe standard Acord 130 application form for workers' comp coverage in Washington. Washington First Report of Injury Form First Report of Injury Form. Employers should complete this form and send to their insurance company each time an injury occurs. Washington Application for Exclusion of Officers and Stockholders WebSearch for Forms and Publications. You can do a search for the forms and/or publications you need below. If there is a form that you're looking for that you can't locate, please … def of possession