Address Change Request for Injured Workers - (Spanish) Solicitud para Cambio de Direccion para Trabajadores Lesionados

Address Change Request for Injured Workers - (Spanish) Solicitud para Cambio de Direccion para Trabajadores Lesionados - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Address Change Request for Injured Workers - (Spanish) Solicitud para Cambio de Direccion para Trabajadores Lesionados (A fillable form - 152 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 F242-388-999
Availability
Online only. See document above to download.
Keywords change of address, claim information, claims, disability, disabled, español, espanol, industrial insurance, time loss compensation, time-loss compensation, worker's compensation, workers compensation, workers' compensation
Languages Spanish , English
Valid dates 07-2011
Contact information Claims for Job Injuries
Web pages Workers' Comp Claims

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.