Application for Indigent Determination (DIME) Forms
| Form Name | Application for Indigent Determination (DIME) |
| Form # | WC35 |
| Form Revision | Rev 10/19 |
| Category | Forms » Medical/Health |
| Downloads | |
| Form State | Colorado |
| Language | English |
| State Description | This application is used by a claimant who is unable to pay the fee(s) required to obtain a Division Independent Medical Examination. |
| Claimwire Description | n/a |