Pension Benefits Questionnaire
See also
| Document Information | ||
|---|---|---|
 Get help downloading & printing files.  How to complete a fillable form. |
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| Title |
Pension Benefits Questionnaire (A fillable form - 56 KB PDF)
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| Description | Used by an injured worker who receives an order that states he or she is totally permanently disabled. This questionnaire must be completed in full and all necessary documents attached before his or her pension benefit options can be calculated. |
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| Detail | ||
| Form number | F242-393-000 | |
| Availability | Online only. See document above to download. |
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| Keywords | claims, disability pension benefits, disabled, industrial insurance, pension disability benefits, permanent total disability, social security offset, sso, worker's compensation, workers compensation, workers' compensation | |
| Languages | English , Spanish | |
| Valid dates | 10-2012 | |
| Contact information | ||
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