Application for Second Injury Fund Benefits Forms
| Form Name | Application for Second Injury Fund Benefits |
| Form # | State Form 51247 |
| Form Revision | (R / 3-22) |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Indiana |
| Language | English |
| State Description | n/a |
| Claimwire Description | The URL provided directs you to Indiana's Workers' Compensation Board, from which you will be able to access the specific form. |