Address Change Request for Pensioners

Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title Address Change Request for Pensioners

Used by the pensioner to notify L&I of a new mailing address. L&I must receive this form by the first day of the month so your monthly payment is received in a timely manner.

Document number F242-107-000
How to get this document
Keywords change of address, disability pension benefits, disabled, espanol, industrial insurance, pension disability benefits, social security offset, spanish, sso, worker's compensation, workers compensation, workers' compensation
Alt Language(s) Español
Valid dates 07/2011
Contact information
Websites Workers' Comp Claims

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.