Address Change Request for Injured Workers

Address Change Request for Injured Workers - (Forms/Publications)
Document Information
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Title Address Change Request for Injured Workers (A fillable form - 164 KB PDF)
Description Completed and signed by a State Fund injured worker to notify L&I of a change in address. All address changes must be submitted in writing and signed by the injured worker.
Detail
Form number F242-388-000
Availability
Online only. See document above to download.
Keywords change of address, claim information, claims, disability, disabled, español, espanol, industrial insurance, spanish, State Fund, time loss, time loss compensation, time-loss, time-loss compensation, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 07-2011
Contact information Claims for Job Injuries
Web pages Workers' Comp Claims

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