Retrospective Rating Adjustment Protest

Document Information
  How to complete a fillable form.
Title Retrospective Rating Adjustment Protest

Used by employers to present L&I with a list of decisions they are protesting by adjustment period. The form requests all necessary elements needed for L&I to process a request for reconsideration.

Document number F250-024-000
How to get this document
Alt Language(s)
Valid dates 04/2013
Contact information Contact Us About Retrospective Rating
Websites Qualify for Refunds

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