Application for Pension Benefits by Spouse or Children
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
||
| Title |
Application for Pension Benefits by Spouse or Children (A fillable form - 163 KB PDF)
|
|
| Description | Used by a spouse or dependent that was chosen by the deceased worker to receive a survivor benefit. At the time the worker was determined to be totally permanently disabled he/she made a decision to leave a survivor benefit to a spouse or dependent if the worker dies. | |
| Detail | ||
| Form number | F242-391-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | disability pension benefits, industrial insurance, permanent total disability, total, worker's compensation, workers compensation, workers' compensation | |
| Languages | English , Spanish | |
| Valid dates | 11-2009 | |
| Contact information | ||
| Web pages | Contact Us About Pension Benefits | |
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