Social Security Offset Calculations Only Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
Social Security Offset Calculations Only Quarterly Statement of Supplemental Benefits Paid for Self-Insured Employers (A fillable form - 128 KB PDF)
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| Description | Used by self-insured employers to request reimbursement from L&I for cost-of-living-adjustments paid to injured workers. | |
| Detail | ||
| Form number | F207-011-222 | |
| Availability | Online only. See document above to download. |
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| Keywords | adjustments, claim information, claims, cola, cost, disability, disabled, injuries, injury, insurance, living, offset, SBP, self-insurance, self-insurer, sso, temporary, total, worker's compensation, workers compensation, workers' compensation | |
| Languages | English | |
| Valid dates | 08-2000 | |
| Contact information |
Self-Insurance
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| Web pages | Self-Insured Employers Insurance for Business |
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