Claim for Pension by Spouse or Children

Claim for Pension by Spouse or Children - (Forms/Publications)
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Title Claim for Pension by Spouse or Children (A fillable form - 140 KB PDF)
Description Used by a spouse or dependents of a deceased worker. The workers' fatal accident or occupational disease incurred in the course of their employment. This application is needed to determine if applicant(s) is/are entitled to a survivor benefit.
Detail
Form number F242-056-000
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Keywords claim information, claims, coverage, disability pension benefits, disabled, espanol, industrial insurance, occupational death, pension disability benefits, social security offset, spanish, sso, surviving children, surviving spouse, worker's compensation, workers compensation, workers' compensation
Languages English , Spanish
Valid dates 03-2008 , 11-2009
Contact information
Related information
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Claim for Pension By Dependents

Address Change Request for Pensioners


Declaration of Entitlement for Widow or Widower Benefits Under Industrial Insurance
Declaration of Entitlement for Guardian Benefits under Industrial Insurance
Declaration of Entitlement for Dependent of Deceased Worker Benefits Under Industrial Insurance
Declaration of Entitlement for Totally Disabled Worker Benefits Under Industrial Insurance

Authorization for Deposit of Payments


Web pages Workers' Comp Claims

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