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A Guide to Workers' Compensation Benefits For Employees of Self-Insured Businesses
Publication
F207-085-000

World Language(s):
Español  
Affidavit for Time Loss Compensation Benefits
Form
F242-395-000

World Language(s):
Español  
Declaración firmada para compensación de tiempo perdido
Form
F242-395-999

World Language(s):
Inglés  
Formulario de estado de empleo (Formulario de verificación de empleo)
Form
F242-052-999

World Language(s):
Inglés  
Self-Insurance Report of Occupational Injury or Disease (SIF-5)
Form
F207-005-000  
Solicitud para cambio de dirección para trabajadores lesionados
Form
F242-388-999

World Language(s):
Inglés  
Work Status Form (formerly Worker Verification Form)
Form
F242-052-000

World Language(s):
Español  
Address Change Request for Injured Workers
Form
F242-388-000

World Language(s):
Español  





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