Preferred Worker Program Quarterly Claim Cost Reimbursement Request Forms
| Form Name | Preferred Worker Program Quarterly Claim Cost Reimbursement Request |
| Form # | 440-3014 |
| Form Revision | 6/23 |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Oregon |
| Language | English |
| State Description | Used by insurers and self-insured employers to request reimbursement from the Workers' Benefit Fund for costs of claims incurred by Preferred Workers. |
| Claimwire Description | n/a |