Application for Pension Benefits by Spouse or Children

Application for Pension Benefits by Spouse or Children - (Forms/Publications)
Document Information
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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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