REPORT OF GROSS ANNUAL INCOME Forms
| Form Name | REPORT OF GROSS ANNUAL INCOME |
| Form # | 440-1614 |
| Form Revision | 1/08 |
| Category | Forms » Financial/Compensation |
| Downloads | |
| Form State | Oregon |
| Language | English |
| State Description | OAR 436-030-0055(5)(b) requires a worker receiving permanent total disability benefits to file a sworn statement of gross annual income when requested by the insurer or self-insured employer. |
| Claimwire Description | n/a |