Address Change Request for Injured Workers
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
Address Change Request for Injured Workers (A fillable form - 164 KB PDF)
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| 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. |
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| 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
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| Web pages | Workers' Comp Claims | |
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