Pension Benefits Questionnaire

Pension Benefits Questionnaire - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Pension Benefits Questionnaire (A fillable form - 56 KB PDF)

Used by an injured worker who receives an order that states he or she is totally permanently disabled. This questionnaire must be completed in full and all necessary documents attached before his or her pension benefit options can be calculated.

Form number F242-393-000
Online only. See document above to download.
Keywords claims, disability pension benefits, disabled, industrial insurance, pension disability benefits, permanent total disability, social security offset, sso, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 10-2012
Contact information

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.