Get a Form or Publication: permanent total disability
Your search for "permanent total disability" returned 6 documents.
See also
| Title | Type | Number |
|---|---|---|
| Application for Pension Benefits by Spouse or Children
Also available in: Spanish 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. |
Form | F242-391-000 |
| Application for Pension Benefits by Spouse or Children - Spanish Aplicación para beneficios de pensión presentado por el cónyuge o hijos
Also available in: English 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. |
Form | F242-391-999 |
| Assignment of Account Agreement
Used by a self-insured employer as an option to provide collateral for a total permanent disability claim. |
Form | F207-058-000 |
| Pension Benefits Questionnaire
Also available in: Spanish Used by an injured worker who receives an order that states he or she is totally permanently disabled. This questionnaire must be completed in full and all necessary documents attached before his or her pension benefit options can be calculated. |
Form | F242-393-000 |
| Pension Benefits Questionnaire - Spanish CUESTIONARIO PARA BENEFICIOS DE PENSIN
Also available in: English Used by an injured worker who receives an order that states he or she is totally permanently disabled. This questionnaire must be completed in full and all necessary documents attached before his or her pension benefit options can be calculated. |
Form | F242-393-999 |
| Self-Insurer's Pension Bond
Used by self-insured employers as an option to provide collateral for a permanent total disability claim. |
Form | F207-065-000 |
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