Address Change Request for Injured Workers

Document Information
  How to complete a fillable form.
Title Address Change Request for Injured Workers
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.
Document number F242-388-000
How to get this document
Alt Language(s) Español
Valid dates 07/2011
Contact information Claims for Job Injuries
Websites Workers' Comp Claims

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