| Document Information | ||
|---|---|---|
Get help downloading & printing files. |
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| Title |
|
|
| Description | Used by an employer to be submitted with the Employer's Quarterly Report for Industrial Insurance as a supplemental reporting form. | |
| Detail | ||
| Form number | F212-223-000 | |
| Availability | Online only. See document above to download. |
|
| Keywords | insurance reporting, worker's compensation, workers compensation, workers' compensation | |
| Languages | English | |
| Valid dates | 08-2009 | |
| Contact information | ||
| Related information | ||
| Documents | Workers' Compensation Employer's Quarterly Report - SAMPLE ONLY |
|
| Web pages | Insurance for Business | |
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