FIRST REPORT OF INJURY OR ILLNESS - EDI Forms
| Form Name | FIRST REPORT OF INJURY OR ILLNESS - EDI |
| Form # | IAIABC IA-1 |
| Form Revision | (8/01) |
| Category | Forms » First Report |
| Downloads | |
| Form State | Mississippi |
| Language | English |
| State Description | The IAIABC IA-1, First report Form has replaced the B-3 Form. The original of this form must be filed with the Commission in all cases involving injuries resulting in lost time in excess of five(5) da |
| Claimwire Description | n/a |