Declaración de Derechos para Padres o Tutor Bajo el Programa de Compensación y Beneficios para Trabajadores

Document Information
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Title   Declaración de Derechos para Padres o Tutor Bajo el Programa de Compensación y Beneficios para Trabajadores (142 KB PDF)
Description

Used by a guardian or other person having custody of the minor or disabled children or dependents of a deceased worker to declare their entitlement to receive the pension benefits for those children/dependents in their care and custody.
Detail
Form number F242-173-922
Availability
Online only. See document above to download.
Keywords claim information, claims, coverage, declaration, disability pension benefits, industrial insurance, occupational death, social security offset, sso, surviving children, surviving spouse, survivor benefits, survivors, worker's compensation, workers compensation, workers' compensation
Languages Spanish , English
Valid dates 11-2009
Contact information
Web pages Workers' Comp Claims

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