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 422 State Forms found

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Authorization to Release Claim Information (Chinese Traditional)

 F101-010-221 07-2023

Authorization to Release Claim Information (Farsi)

 F101-010-233 07-2023

Authorization to Release Claim Information (Korean)

 F101-010-255 07-2023

Authorization to Release Claim Information (Russian)

 F101-010-294 07-2023

Beneficiary Application for Claim Benefits (Somali)

 F242-056-303 07-2016

Workers' Compensation Claim Suppression Complaint Form

 F262-024-000 12-2017

Declaration of Entitlement - Surviving Spouse - Registered Domestic Partner

 F242-420-000 11-2019

Claim Resolution Settlement Income and Expense Worksheet

 F240-007-000 03-2023

Transfer of Attending Provider Form for Self-Insured Workers (Spanish)

 F207-114-999 08-2021

Vocational Training Plan Ownership Agreement for Tools and Equipment (Spanish)

 F245-351-999 4-02

Worker Rights Complaint Form

 F700-148-000 07-2024

Worker Rights Complaint Form (Chinese Simplified)

 F700-148-220 07-2024

Worker Rights Complaint Form (Chinese Traditional)

 F700-148-221 07-2024

Your Independent Medical Exam: For Employees of Self-Insured Businesses

 F207-202-000 06-2023

Your Independent Medical Exam: For Employees of Self-Insured Businesses (Spanish)

 F207-202-999 06-2023
Disclaimer: These forms may not be the most recent version. Washington may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on this site. Please check official sources.
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