Address Change Request for Injured Workers

Address Change Request for Injured Workers - (Forms/Publications)
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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.
Form number F242-388-000
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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