State Fund Claims Address Change Request - Spanish (Solicitud de Cambio de Domicilio para Reclamos del Fonda Estatal)


State Fund Claims Address Change Request - Spanish (Solicitud de Cambio de Domicilio para Reclamos del Fonda Estatal)

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Title	State Fund Claims Address Change Request - Spanish (Solicitud de Cambio de Domicilio para Reclamos del Fonda Estatal) (A fillable form - 170 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
Keywords	address, address change, change address, claim information, claims, disability, disabled, español, espanol, industrial insurance, insurance, spanish, State Fund, time loss, time loss compensation, time-loss, time-loss compensation, worker, worker's compensation, workers compensation, workers' compensation
Languages	Spanish , English
Valid dates	01-2008
Contact information	Claims for Job Injuries
Web pages	Workers' Comp Claims