NOTICE FOR WORKER'S COMPENSATION AND OCCUPATIONAL DISEASES COVERAGE - EDI only Forms
| Form Name | NOTICE FOR WORKER'S COMPENSATION AND OCCUPATIONAL DISEASES COVERAGE - EDI only |
| Form # | State Form 36097 |
| Form Revision | (R8 / 6-15) |
| Category | Forms » Insurance |
| 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. |