Obtenga un formulario o publicación: survivors
Su búsqueda de "survivors" consiguió 11 resultados.
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| Título | Tipo | Número |
|---|---|---|
Declaración de Derechos para Dependiente del Trabajador Fallecido Bajo el Programa de Compensación y Beneficios para Trabajadores Also available in: English Used by a dependent of a worker whose death was related to an on the job injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits. |
Form | F242-173-933 |
Declaración de Derechos para Padres o Tutor Bajo el Programa de Compensación y Beneficios para Trabajadores Also available in: English Used by a guardian or other person having custody of the minor or disabled children or dependents of a deceased worker to declare their entitlement to receive the pension benefits for those children/dependents in their care and custody. |
Form | F242-173-922 |
Declaración de Derechos para Viuda(o) bajo el Programa de Compensación y Beneficios para Trabajadores Also available in: English Used by the widow/widower whose spouse died of a work related injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of your benefits. |
Form | F242-173-911 |
Reclamo para Beneficios de Pensión Presentado por los Dependientes Also available in: English Used by dependents of a deceased worker to file a claim for benefits. |
Form | F242-062-999 |
Request for Survivor Counseling Benefits (English/Spanish) Solicitud para Beneficios de Apoyo para los Sobrevivientes
Used by immediate family members of homicide victims to request mental health counseling. |
Form | F800-057-909 |
When a Loved One Dies at Work - Spanish (Cuando un ser querido fallece en el lugar de trabajo) Also available in: English Brochure: Provides information to loved ones of workers who died from a job-related injury or illness, including how to apply for survivor benefits. Explains the L&I fatality investigation and how family members can stay informed of the investigation's status. |
Publication | F417-240-999 |
| Claim for Pension By Dependents
Also available in: Spanish Used by dependents of a deceased worker to file a claim for benefits. |
Form | F242-062-000 |
| Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance
Also available in: Spanish Used by a dependent of a worker whose death was related to an on the job injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of benefits. |
Form | F242-173-333 |
| Declaration of Entitlement for Guardian Benefits under Industrial Insurance
Also available in: Spanish Used by a guardian or other person having custody of the minor or disabled children or dependents of a deceased worker to declare their entitlement to receive the pension benefits for those children/dependents in their care and custody. |
Form | F242-173-222 |
| Declaration of Entitlement for Widow or Widower Benefits Under Industrial Insurance
Also available in: Spanish Used by the widow/widower whose spouse died of a work related injury or accident. This form must be completed, signed, notarized and returned to L&I within 30 days for non interruption of your benefits. |
Form | F242-173-111 |
| When a Loved One Dies at Work
Also available in: Spanish Brochure: Provides information to loved ones of workers who died from a job-related injury or illness, including how to apply for survivor benefits. Explains the L&I fatality investigation and how family members can stay informed of the investigation's status. |
Publication | F417-240-000 |
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