Application for Pension Benefits by Spouse or Children - (Spanish) Aplicación para Beneficios de Pensión Presentado por el Cónyuge o Hijos

Application for Pension Benefits by Spouse or Children - (Spanish) Aplicación para Beneficios de Pensión Presentado por el Cónyuge o Hijos - (Forms/Publications)
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Title Application for Pension Benefits by Spouse or Children - (Spanish) Aplicación para Beneficios de Pensión Presentado por el Cónyuge o Hijos (A fillable form - 150 KB PDF)
Description

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.

Detail
Form number F242-391-999
Availability
Online only. See document above to download.
Keywords disability pension benefits, industrial insurance, pareja domestica del fallecido, permanent total disability, total, worker's compensation, workers compensation, workers' compensation
Languages Spanish , English
Valid dates 11-2009
Contact information
Web pages Contact Us About Pension Benefits

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